Hepatoblastoma is a rare tumor (an abnormal tissue growth) that originates in cells in the liver. It is the most common cancerous (malignant) liver tumor in early childhood. Most hepatoblastoma tumors begin in the right lobe of the liver. Hepatoblastoma cancer cells also can spread (metastasize) to other areas of the body. The most common site of metastasis is the lungs.

TREATMENT STRATEGY

Specific treatment regimens (drugs, doses and durations) differ according to age group (pediatric, AYA and infant) and sub-type of ALL; however, basic principles of therapy remain same. Treatment consists of induction (to reduce tumor burden and eliminate maximum blasts from bone marrow), consolidation (further eradication of any residual disease), maintenance therapy (to prevent disease relapse) and extramedullary disease prophylaxis or treatment (to prevent CNS relapse and clear leukemic cells from sites which are not accessible by systemic chemotherapy due to blood brain barrier). The guideline recommends enrolling patients in clinical trials, whenever possible.

Treatment of Specific Groups

Ph negative and Ph – likeB-ALL: NCCN recommends pediatric and AYA patients with Ph negative or Ph – like should be grouped according to risk criteria and multi-agent induction be given.Patients who are MRD negative at end of induction (EOI) continue treatment on same risk arm. Patients, who are MRD positive at EOI are given intensified consolidation. In case of persistent MRD despite intensified chemotherapy, blinatumumab or tisagenlecleucel (Category 2B) can be considered. In all MRD positive cases at EOI, hematopoietic stem cell transplant (HSCT) may be considered as a part of consolidation or maintenance therapy.

Ph positive B-ALL: Pediatric and AYA patients with Ph positive disease should be treated with tyrosine kinase inhibitor containing protocols. Those who achieve MRD negative at EOI may continue the same protocol with tyrosine kinase inhibitor. For those who are MRD positive at EOI, blinatumumab or tisagenlecleucel (Category 2B) can be considered. The panel recommends HSCT for consolidation followed by post-transplant tyrosine kinase inhibitor.

T-ALL: The guideline recommends systemic chemotherapy. Those who have MRD >0.1% at end of consolidation should receive intensified chemotherapy to attain MRD negativity and thenceforth be considered for HSCT as consolidation therapy. Addition of nelrabine should be strongly considered in all patients with T cell ALL who are MRD positive or have CNS disease at diagnosis or those who fail induction.

Infant ALL: Infant ALL is to be treated with Interfant-based regimen that incorporates elements of ALL and AML therapy [9]. Assessment of baseline KMT2A status is essential. Infants without KMT2A rearrangement and MRD negative at EOI, continue to receive the Interfant consolidation, those who are MRD positive may receive intensified consolidation and HSCT may be considered. Those with KMT2 rearranged, are treated with intensive Interfant-based consolidation. High-risk patients (<3 months with any WBC, <6 months with WBC >3,00,000, persistent MRD after intensified consolidation) may receive maintenance therapy or may be considered for HSCT, non TBI regimen are preferable. For non-high-risk, KMT2 rearranged patients, usual maintenance therapy is recommended.

FAMILY DETAILS OF THE CHILD –

Mr. Babasaheb Raskar  (Father of Baby) is a Private Worker. His Yearly Income is 48000 INR Per annum which is very low. Their economic condition is not good & managing his daughter’s treatment cost is impossible.
His family have spent a lot of money for the treatment of the child and exhausted all their resources. Now they are unable to pay for the treatment. We request you please save his  daughter’s life as they are in urgent need.

PATIENT DETAILS –

Miss Payal Babasaheb Raskar – 06 Years Old Female Child is Under Care for her B Cell – A.L.L- Acute Lymphoblastic Leukemia (High Risk Blood Cancer) & her treatment is going on KEM Hospital, Pune.We request you to support this Child. This Baby is under Cancer Care centre of KEM PUNE. The Child’s are advised for 4-8 CYCLES OF CHEMOTHERAPY by BFM Protocol and is responding well to anti cancer drugs with supportive care under Dr. S Kannan (DNB Pediatrics, DM Haem-oncology Paediatric Haematology ) KEM Hospital, Pune. It is long duration treatment with approx. expenditure of 6,00,000/- Which Includes Hospital Charges, Chemotherapy Charges, Supportive Charges, Blood Charges & Other Additional Expenses.