• New York State Department of Health. Pediatric malignancies. New York (NY): New York State Department of Health; 2004. 9 p. [16 references]

This is the current release of the guideline.

• Human immunodeficiency virus (HIV) infection
• HIV-related malignancies, such as non-Hodgkin's lymphoma (NHL), Hodgkin's disease, leiomyoma, leiomyosarcoma, Kaposi's sarcoma (KS)

Evaluation
Management

Allergy and Immunology
Family Practice
Infectious Diseases
Oncology
Pediatrics

Advanced Practice Nurses
Health Care Providers
Physician Assistants
Physicians
Public Health Departments

To develop guidelines for management of pediatric malignancies in human immunodeficiency virus (HIV)-infected children

Human immunodeficiency virus (HIV)-infected children with malignancies

1. Evaluating patients for malignancies
2. Referral to pediatric oncologist
3. Highly active antiretroviral therapy (HAART)
4. Chemotherapy for malignancies
5. Close monitoring for therapy side effects and drug-drug interactions

• Relative risk of non-Hodgkin's lymphomas (NHL), Hodgkin's disease, leiomyomas, leiomyosarcomas, and Kaposi's sarcomas (KS) in human immunodeficiency virus (HIV)-infected children
• Efficacy and safety of combination of highly active antiretroviral therapy (HAART) and chemotherapy

Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

Not stated

Not stated

Expert Consensus (Committee)

Not applicable

Review

Not stated

Expert Consensus

The Human Immunodeficiency Virus (HIV) Guidelines Program works directly with committees composed of HIV Specialists to develop clinical practice guidelines. These specialists represent different disciplines associated with HIV care, including infectious diseases, family medicine, obstetrics and gynecology, among others. Generally, committees meet in person 3 to 4 times per year, and otherwise conduct business through monthly conference calls.

Committees meet to determine priorities of content, review literature, and weigh evidence for a given topic. These discussions are followed by careful deliberation to craft recommendations that can guide HIV primary care practitioners in the delivery of HIV care. Decision making occurs by consensus. When sufficient evidence is unavailable to support a specific recommendation that addresses an important component of HIV care, the group relies on their collective best practice experience to develop the final statement. The text is then drafted by one member, reviewed and modified by the committee, edited by medical writers, and then submitted for peer review.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Peer Review

Not stated

Types of Malignancies

When human immunodeficiency virus (HIV)-infected children present with unexplained constitutional symptoms, such as fever, weight loss, hepatomegaly, splenomegaly, jaundice, abdominal distension, central nervous system (CNS) symptoms, pancytopenia, and bone pain, clinicians should evaluate for malignancy.

Key Points: Proliferative and neoplastic disorders may clinically mimic an opportunistic infection.

The only malignancy found primarily in children with more advanced immunodeficiency is primary CNS lymphoma.

Treatment

Clinicians should refer HIV-infected children with malignancies to pediatric oncologists.

Clinicians should initiate or continue highly active antiretroviral therapy (HAART) while the patient is undergoing treatment for the malignancy; however, there is the possibility of an increase in side effects and complex drug-drug interactions.

Treatment of HIV-infected children with malignancies should be managed by a multidisciplinary team, including pediatric hematologists/oncologists, pediatric HIV specialists, and pharmacists.

Key Point: Because the regimens used to treat malignancies (particularly those required for treating advanced B-cell lymphomas) are extremely aggressive, it is important to be vigilant for associated toxicities and drug-drug interactions.

None provided

The type of evidence supporting the recommendations is not stated.

Appropriate management of human immunodeficiency virus (HIV)-infected children with malignancies

Toxicities and drug interactions of treatment

Following the development and dissemination of guidelines, the next crucial steps are adoption and implementation. Once practitioners become familiar with the content of guidelines, they can then consider how to change the ways in which they take care of their patients. This may involve changing systems that are part of the office or clinic in which they practice. Changes may be implemented rapidly, especially when clear outcomes have been demonstrated to result from the new practice such as prescribing new medication regimens. In other cases, such as diagnostic screening or oral health delivery, however, barriers emerge which prevent effective implementation. Strategies to promote implementation, such as through quality of care monitoring or dissemination of best practices, are listed and illustrated in the companion document to the original guideline (HIV clinical practice guidelines, New York State Department of Health; 2003), which portrays New York's HIV Guidelines Program. The general implementation strategy is outlined below.

• Statement of purpose and goal to encourage adoption and implementation of guidelines into clinical practice by target audience
• Define target audience (providers, consumers, support service providers).
  • Are there groups within this audience that need to be identified and approached with different strategies (e.g., HIV Specialists, family practitioners, minority providers, professional groups, rural-based providers)?
• Define implementation methods.
  • What are the best methods to reach these specific groups (e.g., performance measurement consumer materials, media, conferences)?
• Determine appropriate implementation processes.
  • What steps need to be taken to make these activities happen?
  • What necessary processes are internal to the organization (e.g., coordination with colleagues, monitoring of activities)?
  • What necessary processes are external to the organization (e.g., meetings with external groups, conferences)?
  • Are there opinion leaders that can be identified from the target audience that can champion the topic and influence opinion?
• Monitor progress.
  • What is the flow of activities associated with the implementation process and which can be tracked to monitor the process?
• Evaluate.
  • Did the processes and strategies work? Were the guidelines implemented?
  • What could be improved in future endeavors?

Getting Better
Living with Illness

Effectiveness

• New York State Department of Health. Pediatric malignancies. New York (NY): New York State Department of Health; 2004. 9 p. [16 references]

Not applicable: The guideline was not adapted from another source.

2004

New York State Department of Health - State/Local Government Agency [U.S.]

New York State Department of Health

Committee for the Care of Children and Adolescents with HIV Infection

Committee Chair: Jeffrey M. Birnbaum, MD, MPH, Assistant Professor of Pediatrics, SUNY Health Sciences Center at Downstate, Brooklyn, New York, Director, HEAT Program, Kings County Hospital

Committee Vice Chair: Geoffrey A. Weinberg, MD, Director, Pediatric HIV Program, Strong Memorial Hospital, Rochester, NY, Associate Professor of Pediatrics, Division of Infectious Diseases, University of Rochester School of Medicine and Dentistry

Committee Members: Jacobo Abadi, MD, Assistant Professor of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, Jacobi Medical Center; Saroj S. Bakshi, MD, Associate Professor of Clinical Pediatrics, Albert Einstein College of Medicine, Bronx, New York, Chief, Division of Pediatric Infectious Diseases, Bronx-Lebanon Hospital Center; Howard J. Balbi, MD, Associate Professor of Pediatrics, SUNY at Stony Brook School of Medicine, Director, Pediatric Infectious Diseases, Good Samaritan Hospital Medical Center; Joseph S. Cervia, MD, Associate Professor of Clinical Medicine and Pediatrics, Albert Einstein College of Medicine, Bronx, New York, Director, The Comprehensive HIV Care and Research Center, Long Island Jewish Medical Center; Aracelis D. Fernandez, MD, Assistant Professor of Pediatrics, Albany Medical College; Ed Handelsman, MD, Assistant Professor of Pediatrics, SUNY Health Sciences Center at Downstate, Assistant Medical Director of Pediatrics, Office of the Medical Director, AIDS Institute; Sharon Nachman, MD, Chief, Pediatric Infectious Diseases, Professor of Pediatrics, SUNY at Stony Brook; Natalie Neu, MD, Assistant Professor of Pediatrics, Division of Pediatric Infectious Diseases, Columbia University; Catherine J. Painter, MD, PhD, Assistant Professor of Clinical Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York, Medical Director, Incarnation Children's Center; Roberto Posada, MD, Assistant Professor of Pediatrics, Division of Pediatric Infectious Diseases, Mount Sinai School of Medicine, New York, New York, Director, Pediatric HIV Program, Mount Sinai Hospital; Michael G. Rosenberg, MD, PhD, Associate Professor of Clinical Pediatrics, Albert Einstein College of Medicine, Bronx, New York, Pediatric Consultation Services, Jacobi Medical Center; Pauline Thomas, MD, Assistant Professor, Dept. of OB/GYN and Women's Health, Dept. of Preventive Medicine and Community Health, New Jersey Medical School; Barbara Warren, BSN, MPH, PNP, Assistant Director, Bureau of HIV Ambulatory Care Services, AIDS Institute, New York State Department of Health

Not stated

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI on January 13, 2005.