title: Synchronous occurrence of acute lymphoblastic leukemia and wilms tumor in two patients: underlying etiology and combined treatment plan.
abstract: Synchronous cancers are extraordinarily rare in pediatric patients and present a therapeutic challenge. Patient A presented with synchronous unilateral Wilms tumor (WT) and standard-risk (SR) B-precursor acute lymphoblastic leukemia (ALL). Genetic testing revealed bialleleic BRCA2/FANCD1 mutations. Patient B, after SR B-precursor ALL induction therapy, was noted on fever workup to have a renal mass; pathology demonstrated lesion indeterminate between WT and nephrogenic rest. Therapy was customized for each patient to treat both cancers. Both patients have ongoing remission from their cancers, without excessive toxicity. We report two regimens for treating synchronous WT and ALL and recommend screening such patients for cancer predisposition.
authors.affiliation: Pediatric Hematology/Oncology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.
authors.forename: Joanna S
authors.initials: JS
authors.lastname: Yi
authors.affiliation: Department of Pediatric Oncology, Dana-Farber/Cancer Institute, Harvard Medical School, Boston, Massachusetts.
authors.forename: Junne
authors.initials: J
authors.lastname: Kamihara
authors.affiliation: Department of Pediatric Oncology, Dana-Farber/Cancer Institute, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Kesselheim
authors.affiliation: Department of Pediatric Oncology, Dana-Farber/Cancer Institute, Harvard Medical School, Boston, Massachusetts.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Davies
authors.affiliation: Pediatric Hematology/Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Jack
authors.initials: J
authors.lastname: van Hoff
authors.affiliation: Department of Pediatric Oncology, Dana-Farber/Cancer Institute, Harvard Medical School, Boston, Massachusetts.
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Silverman
authors.affiliation: Department of Pediatric Oncology, Dana-Farber/Cancer Institute, Harvard Medical School, Boston, Massachusetts.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Mullen
mesh_terms: D024682:BRCA2 Protein / Q000235:genetics*; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005199:Fanconi Anemia / Q000150:complications / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D009378:Neoplasms, Multiple Primary / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000473:pathology / Q000628:therapy*; D009396:Wilms Tumor / Q000150:complications / Q000473:pathology / Q000628:therapy*
chemical_list: D024682:BRCA2 Protein; C551750:BRCA2 protein, human
keywords: ALL; Wilms tumor; cancer predisposition; fanconi anemia; synchronous