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One of the great success stories of clinical oncology is the improvement in the curerates of pediatric acute lymphoblastic leukemia (ALL) from around 10% in the 1960s tonearly 90% today. The primary factor responsible for this remarkable improvement is thepersonalization of treatment, with stratification of patients based on both disease andhost characteristics in order to optimize therapy. While age, WBC, and immunophenotypeprovide a rudimentary system for classification of ALL, molecular factors are playingan increasingly important role in further individualization of ALL therapy. Such riskbasedstratification strategies are also increasingly being used in the treatment of childrenwith solid tumors. In addition, genomic technologies are now being used to identifynew molecular markers or signatures for both diagnostic and prognostic purposes.Recently we reported the analysis of pediatric osteosarcoma by expression profiling in anattempt to identify a molecular signature that could predict the chemoresistance of atumor before treatment is initiated. We identified a 45-gene signature that discriminatesbetween good and poor responders to chemotherapy in osteosarcoma. Using this classifier,we can predict with 100% accuracy the chemoresponse of osteosarcoma patientsprior to the initiation of treatment. These encouraging results suggest that the genomicapproach will revolutionize the diagnosis and prognosis of pediatric cancer patients andimprove their outcome through predictive, personalized care.

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Subject: Personalized Nutrition for the Diverse Needs of Infants and Children62nd Nestlé Nutrition Workshop, Pediatric Program, Helsinki, September 2007 > 173 - 188: Personalized Care of Pediatric Cancer Patients

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