Update on Recommendations for Surveillance for Children with Predisposition to Hematopoietic
Malignancy
Children with certain germline gene variants have an increased risk of developing myelodysplastic syndrome
(MDS) and other hematopoietic malignancies (HM), such as leukemias and lymphomas. Recent studies have
identified an expanding number of these predisposition genes, with variants most prevalent in children with
MDS but also found in other HM. For some hematopoietic malignancy predisposition (HMP) disorders,
specifically those with a high risk of MDS, early intervention through hematopoietic stem cell transplantation
(HSCT) can favorably impact overall survival, providing a rationale for rigorous surveillance. A multidisciplinary
panel of experts at the 2023 AACR Childhood Cancer Predisposition Workshop reviewed the latest advances
in the field and updated prior 2017 surveillance recommendations for children with HMP. In addition to general
guidance for all children with HMP, which includes annual physical examination, education about the signs and
symptoms of HM, consultation with experienced providers, and early assessment by an HSCT specialist, the
panel provided specific recommendations for individuals with a higher risk of MDS based on the affected gene.
These recommendations include periodic and comprehensive surveillance for individuals with those
syndromes associated with higher risk of MDS, including serial bone marrow examinations to monitor for
morphologic changes and deep sequencing for somatic changes in genes associated with HM progression.
This approach enables close monitoring of disease evolution based on the individual's genetic profile. As more
HMP-related genes are discovered and the disorders' natural histories are better defined, these personalized
recommendations will serve as a foundation for future guidelines in managing these conditions.
Clinical Cancer Research, 2024
