Children's Cancer Hospital Newsletter - Summer 2010 by MD Anderson Cancer Center

NEWSLETTER Children’s Cancer Hospital at The University of Texas MD Anderson Cancer Center: George Foreman Pediatric and Adolescent Inpatient Unit

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Pediatric patient benefits from proton therapy

Robin Bush Child and Adolescent Clinic Kim’s Place R.E. (Bob) Smith Research Facility

Our MISSION To cure cancer

in children and young adults within a caring, life-affirming environment.

Contact us at 713-792-5410 8 a.m.–5 p.m. (M–F) and after hours at 713-792-7090. Request the on-call pediatric oncology attending.

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www.mdanderson.org/children

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Our VISION We will offer children and young adults hope and an opportunity to lead full and productive lives. We will lead the efforts worldwide to cure cancers through the excellence and compassion of our people, research-driven innovative therapies, education programs and active collaboration with patients, families and communities.

Two years after his son Jake’s grueling but successful treatment for childhood cancer, powerful feelings are still close to the surface for Joe Cunniffe of McLean, Va. Chief among them are shock, fear, gratitude and relief.

ust after Jake’s third birthday in early 2008, the little boy was diagnosed with rhabdomyosarcoma, a soft tissue cancer in children. Tests revealed that the tumor was attached to his bladder, which explained why urination had become so difficult for him. The tumor’s size and location — and Jake’s age — made choosing an effective course of treatment especially complicated. Composed of cells that normally develop into skeletal muscles, rhabdomyosarcomas occur most often in children and teens. They represent about 3 percent of all childhood cancers, and approximately 350 new cases of rhabdomyosarcoma occur each year in the United States.

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Proton Therapy

Doctors

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nita Mahajan, M.D., associate professor in the Department of Radiation Oncology, Division of Radiation Oncology, was born in London, but grew up in Canada and is still officially a Canadian citizen. continued from page 1

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Proton therapy offers ‘remarkable chance’

After consulting with experts at a local hospital in Virginia and getting a second opinion from another team at Johns Hopkins Hospital in Baltimore, Md., Cunniffe and his wife Amy elected to augment Jake’s chemotherapy treatment with an emerging, though lesser-known, form of radiation called proton beam therapy. Because their bodies are still developing, children may have more serious long-term side effects from radiation treatment — intellectual impairment, decreased bone and soft tissue growth, hormonal deficiencies and the development of second tumors. But with its capability to precisely deliver high doses of radiation to the tumor with little damage to surrounding normal tissue, proton beam therapy is increasingly being used to treat cancer in pediatric patients. The Cunniffes were convinced that chemotherapy and proton therapy offered the best chance to cure this difficult cancer, whose location near Jake’s developing organs made its removal tricky and dangerous. “Our radiation oncologist at Johns Hopkins felt that the combination of chemotherapy and proton therapy offered Jake ‘a remarkable chance’ of eliminating the tumor,” Cunniffe recalls.

But where to go for this therapy?

“He told us proton beam therapy is available in just five places in the country (at the time). And due to its wealth of experience in treating children, he recommended MD Anderson,” Cunniffe says. The Cunniffes met a number of physicians and medical professionals who would become their partners in returning Jake to health. Among them was Anita Mahajan, M.D., associate professor in MD Anderson’s Department of Radiation Oncology. Because of her expertise in treating pediatric tumors, she led Jake’s care team. Cancer treatment for a young child requires special accommodations. This is especially true for proton therapy, whose precision is the key to its success in killing cancerous tissue while sparing healthy tissue. Children have a harder time holding still, so those under age 8 require sedation before treatment. Mahajan and Vivian Porche, M.D., professor in the Department of Anesthesiology and Perioperative Medicine, were determined to make it as easy and interactive as possible for Jake. Porche taught him how to “put himself to sleep” for the treatments, allowing him to push the button that started the anesthesia. Then she and nurse anesthetist Cynthia Williams sang him lullabies until he fell asleep. Cunniffe, who usually accompanied Jake to his proton treatments because his wife was home in Virginia with their younger child, still gets choked up when he remembers Porche’s promise to him: “I’m your baby’s mama when your baby’s mama isn’t here.” During their five weeks in Houston, the family stayed in the Ronald McDonald House. This made it easy when Amy and baby Lucy visited Joe and Jake every weekend. “We were treated like royalty,” Cunniffe says. Two years later, Jake is a healthy, happy 5-year-old.

Children’s Cancer Hospital • Summer 2010

A graduate of the University of Toronto in biochemistry, Mahajan went on to receive her medical degree from McGill University in Montreal, where she also did her internship and radiation oncology residency. A proton therapy fellowship in 1996 brought her “south of the border” to Massachusetts General Hospital in Boston. “Thanks to my family and my work, I’ve lived lots of places,” Mahajan says. “Fortunately, I love to travel.” Married with two teenage boys, Mahajan says that pediatrics is a great place for her to focus. “I enjoy working with pediatric proton patients because I know that MD Anderson has the expertise and appropriate back-up facilities to take care of any problems we may run into in our work. Besides that, pedi patients are fun and they give good hugs.”

ivian H. Porche, M.D., professor in the Department of Anesthesiology and Perioperative Medicine, Division of Anesthesiology and Critical Care, has been the medical director of anesthesia for the Proton Therapy Center since 2005. Porche, who had a lifelong desire to be a doctor, grew up in a household of collegeeducated African-Americans. After a “fun” college experience, Porche attended The University of Texas Health Science Center at Houston to obtain her medical degree. She married during her last year in medical school, had her first child’s birth during her residency in anesthesiology at Baylor College of Medicine in Houston, and her second child shortly after taking a position at MD Anderson. Her third child was born later in her career at MD Anderson. Today, Porche continues to pursue her goals in the Proton Therapy Center. She’s known for being interactive with her young patients, from teaching them how to “put themselves to sleep” by pushing the button that starts the anesthesia to singing lullabies to help sleep come faster.

Q andA

Anita Mahajan, M.D., above, associate professor in MD Anderson’s Department of Radiation Oncology, answers questions about proton therapy for pediatric cancer patients.

What is proton therapy?

Proton therapy is an advanced form of radiation therapy that uses protons, which are charged particles from an atom. The advantage of proton therapy over traditional forms of radiation treatment is its ability to deliver a pencil-thin beam of radiation to the tumor area with remarkable precision — within one millimeter — that avoids the surrounding tissue, generates fewer side effects and improves tumor control. Proton therapy requires a highly specialized machine to deliver treatment, as well as a highly trained staff to ensure the best planning and treatment.

How does it differ from traditional (photon) therapy?

Proton therapy is different from traditional X-ray or photon therapy because it aims high-energy protons very accurately at the area of concern. Once protons enter the body, they deposit their energy (dose) at a precise location and stop, allowing no dose of radiation to go farther into the body. With more common radiation treatments that use X-rays (also known as photons or gamma rays), radiation is aimed precisely at the tumor. However, some radiation continues through the body, radiating organs and tissues that may not require treatment. This dose is called the “exit dose” and is almost non-existent with proton therapy.

What are its advantages?

The biggest advantage of proton therapy for children is that it reduces the dose to the body outside of the tumor area. In addition, there tends to be less radiation deposited between the entry point on the surface of the patient’s body to the target area, known as the “entrance dose.” Proton therapy may allow more aggressive treatment of tumors near or within sensitive organs, such as the lungs. In children, there may be a reduction in side effects with proton therapy. There’s convincing evidence that even low doses of traditional radiation can increase the risk of secondary tumors.

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Proton therapy for pediatric patients What pediatric cancers is proton therapy recommended for?

Proton therapy has been used for several different pediatric cancers, including brain tumors, sarcoma and lymphoma. It can and should be considered for any child who is receiving aggressive curative treatment where moderate to high doses of radiation are required.

Are there special considerations when working with pediatric patients?

Young children and some older patients require daily sedation to help them stay still for any radiation. Reliable anesthesia support is absolutely necessary to allow safe and efficient radiation delivery. Treating children with radiation is very challenging and rewarding. We’ve made great strides in curing many more childhood cancers, but we also realize that these young patients have many side effects as they grow older from the therapies that have helped cure their cancers. When treating children, we realize that they require aggressive therapy including surgery, chemotherapy and radiation therapy. We have to be aware of their previous and ongoing therapies, and we must consider their age, growth potential and functional development to minimize side effects and maximize their future quality of life.

What else should parents know about this therapy?

Proton radiation is an exciting technology that may help reduce side effects during and after therapy. It should be part of a multidisciplinary approach that’s common for many childhood malignancies. So far, results indicate that the rate of successful treatments is identical to traditional radiation, with a potential added benefit of fewer side effects. Proton therapy also requires daily sessions (five days a week) for up to six weeks, depending on the particular tumor type. Patients may still have side effects, in particular from the organs and tissues adjacent to the tumor since part of them will receive most, if not the full, dose of radiation.

The University of Texas MD Anderson Cancer Center • Division of Pediatrics

It’s more than skin deep

or years, children have been playing in the sun and teens and young adults have being taking in the rays to work on suntans. However, we’ve all learned that, while the sun makes the world appear happy and bright, it can also be a deadly enemy.

Children develop melanoma, too Pediatric cancer in general is a rare disease. Each year, pediatric oncologists treat some 750 children up to age 20 for melanoma. Most of this disease is low stage, requiring only a biopsy and surgical removal. Some pediatric patients, however, may not receive the right care and follow-up for this cancer. To put this in perspective, these numbers are similar to those reported for pediatric osteosarcoma. In the MD Anderson Children’s Cancer Hospital, Dennis Hughes, M.D., Ph.D., and Cynthia Herzog, M.D., report seeing approximately 12 melanoma patients each year who actually merit treatment. Most often, patients with a suspected melanoma are first evaluated and then treated surgically until there is no remaining evidence of the disease. With high-stage melanoma, interferon treatment is given five times per week for a month and then in reduced amounts for a year. The best care for these patients is to make certain that the disease has not spread to the sentinel lymph node. Checking this involves two injections into the site of the biopsy. The first is with a lymphoscitigraphy, which is a radiotracer that sends a dye back to the involved lymph node or nodes. This allows the surgeon to determine which lymph node to remove. On occasion, an entire bed of lymph nodes must be taken out. This can change the way that fluids drain from that site and may eventually result in endema and then other cancers. The second injection occurs on the morning of surgery when a blue colloid dye is shot into the site of the melanoma. The dye stains the relative lymph node blue so that it is easy to determine which one or ones to remove. In children, most melanomas may be the result of a genetic predisposition. If a child gets a bad sunburn, it is usually 10 years before a melanoma appears, which is why the more typical sun-caused skin cancers are found in teens and those older. After treatment for an initial melanoma diagnosis, the greatest lifelong risk is that a new spot located somewhere on the body may become melanoma, not that the old one will reoccur.

Children’s Cancer Hospital • Summer 2010

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Aside from the healthy dose of vitamin D that sunshine provides, the consequence of UVA and UVB rays from the sun can be severe. For many adults, the build-up of skin damage caused by overexposure to the sun results in a form of skin cancer called melanoma. Occasionally, that same type of cancer is found in children.

Keeping melanoma at bay The best form of treatment is prevention. As Hughes says, “If your skin has already figured out how to make a melanoma, why give it help?” His recommendation is to take the children along when shopping for sunscreen and other skin care products because it’s difficult to impose something on pediatric patients that they find objectionable. For boys, the clear, alcohol-based product is usually a pleaser. Girls are fonder of the floral-scented sunscreens and can normally find several sunscreens that they will use. “The easier it is to apply, the happier the children are with it,” Hughes says. He also says that the spray-on variety works well as long as hands are used to spread it onto the body. One caution is to apply sunscreen prior to donning a bathing suit. “If you put the sunscreen on at home before you go to the beach or pool, the half hour it takes to become effective will be passed by the time you arrive. You’ll also miss those ‘edge burns’ that you may get when you try to put on the sunscreen around your bathing suit,” Hughes explains. Keep in mind the difference between sunscreen and sunblock. Sunscreen contains molecules that can absorb the sun’s energy and prevent it from getting into the skin. Sunblock is metal salt that reflects the sun’s energy away from the skin. Both are effective as long as they are reapplied every two to four hours. Hughes recommends that everyone use a water-proof sunscreen with a minimum of a 30 spf, which is the measure of the proportion of UV light blocked. A 30 spf sunscreen means that 97 percent of the sun’s energy is blocked. With a 50 spf, 98 percent is blocked, and with an 85 spf, approximately 99 percent is blocked. While sun-protective clothing and sunglasses are also good ideas, especially for younger children, a hat is a must. If you don’t have a hat, don’t forget the head when applying sunscreen, especially along parts in the hair. An alcohol-based product is best for the head because it is non-greasy. Children with light coloring in their skin, hair and eyes are predisposed to melanomas, as are those with lots of moles, which are precursors to melanoma. However, even dark-skinned Latin Americans and African-Americans can get melanoma.

DIVISION OF PEDIATRICS

When checking for melanoma, look for the ABCDE danger signs in any moles or pigmented spots: • Asymmetry – one half is unlike the other half • Border – an irregular, scalloped or poorly defined border • Color – is varied from one area to another; has shades of tan, brown or black; is sometimes white, red or blue • Diameter – melanomas are usually larger than the size of a pencil eraser when diagnosed, but may be smaller • Evolving – a mole or skin lesion that looks different from the rest or is changing in size, shape or color

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Finding, diagnosing and treating melanomas With children, it’s important to find a team that is experienced in diagnosing and treating pediatric patients with melanoma. This team should include a pediatric oncologist, an experienced melanoma dermatopatholgist who has experience doing a sentinel node analysis and a surgical oncologist who is experienced in sentinel node mapping and biopsy. Most pediatric melanomas are treated with surgery. Those that are low-stage may only require observation after surgery; however, those melanomas that have spread to the lymph nodes may need additional treatment such as biologic therapy, chemotherapy or both. A diagnosis of pediatric melanoma requires lifelong skin checks and follow-up with an experienced melanoma oncologist. As Hughes explains, there is no rewind button. “You can’t change the future possibility of having melanoma, but you can change how early you might develop “There is no melanoma. And, once you such thing as have a melanoma, you a safe skin,” have an increased risk of Hughes says. having more.”

Academic Office: 713-792-6620 Division Head Eugenie Kleinerman, M.D. Deputy Division Head Robert Wells, M.D. Adolescent/Young Adult Anna Franklin, M.D. Martha Askins, Ph.D. Michael Rytting, M.D. Bone Marrow Transplantation Laurence Cooper, M.D., Ph.D. Susan Kelly, M.D. Dean A. Lee, M.D., Ph.D. Demetrios Petropoulos, M.D. Laura Worth, M.D., Ph.D. Brain/Neural Tumors Johannes Wolff, M.D. Joann Ater, M.D. Vidya Gopalakrishnan, Ph.D. Tribhawan Vats, M.D. Endocrinology Steven Waguespack, M.D. Anita Ying, M.D. Hematology Deborah Brown, M.D. Nydra Rodriguez, M.D. Leukemia/Lymphoma Robert Wells, M.D. Joya Chandra, Ph.D. Anna Franklin, M.D. Cesar Nunez, M.D. Michael Rytting, M.D. Patrick Zweidler-McKay, M.D., Ph.D. Nephrology Joshua Samuels, M.D., M.P.H. Neurology/Neurofibromatosis Bartlett Moore, Ph.D. John Slopis, M.D., M.P.H. Non-Neural Solid Tumors Peter M. Anderson, M.D., Ph.D. Nancy Gordon, M.D. Cynthia Herzog, M.D. Dennis Hughes, M.D., Ph.D. Winston Huh, M.D. Shulin Li, Ph.D. Eugenie Kleinerman, M.D. Peter Zage, M.D., Ph.D. Critical Care Jose Cortes, M. D. Rodrigo Mejia, M.D. Regina Okhuysen-Cawley, M.D. Pediatric Surgery Richard Andrassy, M.D. Charles Cox, M.D. Andrea Hayes-Jordan, M.D. Kevin Lally, M.D. KuoJen Tsao, M.D. Orthopedic Surgery Valerae O. Lewis, M.D. Patrick P. Lin, M.D. Bryan Moon, M.D. Neurosurgery Raymond Sawaya, M.D. Fred Lang, M.D. Jeffrey Weinberg, M.D. Psychology Martha Askins, Ph.D. Bartlett Moore, Ph.D. Rhonda S. Robert, Ph.D.

Dennis Hughes, M.D., Ph.D., joins two of his patients, 9-year-old Mikayla Reitgraf (left) and 14-year-old Caitlyn Mortus (right) at The Kinkaid School-sponsored lacrosse tournament benefitting the MD Anderson Children’s Cancer Hospital. In addition to his physician duties, Hughes has used his singing talents at several awareness events for the Children’s Cancer Hospital.

Survivorship Joann Ater, M.D. Winston Huh, M.D.

The University of Texas MD Anderson Cancer Center • Division of Pediatrics

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Research Updates MD Anderson zeroes in on better way to predict prognosis in pediatric leukemia patients Patrick Zweidler-McKay, M.D. Ph.D., assistant professor at the Children’s Cancer Hospital, was the first author on a study about a way to more accurately predict treatment outcomes in young leukemia patients using information from a common and simple complete blood count test, also known as a CBC. The results of a retrospective study were reported at the American Society of Pediatric Hematology Oncology’s (ASPHO) annual meeting held in April. The study illustrated that the minimal residual disease (MRD) indicator and the absolute lymphocyte count (ALC) together help physicians better predict which patients with acute lymphocytic leukemia (ALL) will remain disease free and who will most likely relapse. For several years, MRD has been the best prognostic tool used to predict whether a patient was at high risk for relapse. At the 2007 ASPHO annual meeting, Zweidler-McKay reported that the ALC count can also be influential in predicting prognosis of pediatric leukemia patients. In this current

Patrick Zweidler-McKay consults with Eugenie Kleinerman, M.D., and a Children’s Cancer Hospital fellow over lab results.

study, results showed that ALC is as powerful as MRD, if not more, in independently predicting prognosis for children with ALL. By using ALC as a prognostic tool along with MRD, researchers were able to define a subgroup of patients who are more prone to relapse but were originally overlooked based on using MRD alone to predict prognosis. “MRD is an important tool for predicting prognosis,” says Zweidler-McKay, “but it misses a subgroup of patients who, despite having low MRD, still are at high risk of relapse. Using the ALC information, we can define which patients fall into this category. Down the line, we hope this information will allow us to alter treatment to help prevent these patients from relapsing.”

Surgical procedure offers new option for pediatric patients with rare cancer in abdomen Andrea Hayes-Jordan, M.D., left, assistant professor at the Children’s Cancer Hospital, co-authored a study with physician assistant Holly Green that showed that an adult surgery adapted for use in young patients increased the survival of children with rare tumors in the abdomen. Hayes-Jordan is the first and only surgeon in the country to perform the adult procedure on children using heated chemotherapy. The study, reported in the May 20 issue of the Journal of Pediatric Surgery, looked retrospectively at 24 pediatric patients diagnosed with a rare and aggressive pediatric cancer known as desmoplastic small round cell tumor (DSRCT). Patients who received the surgical procedure called hyperthermic intraperitoneal chemotherapy (HIPEC), or “heated chemotherapy,” had an overall three-year survival rate of 71 percent. For patients who received only standard treatment, 26 percent survived three years. Previous studies have shown the synergy created when chemotherapy is heated. With HIPEC, Hayes-Jordan will spend 10 to 12 hours removing, or debulking, the hundreds of tumors in a patient’s abdominal cavity. Then she will run the chemotherapy, heated at 40 to 41 degrees Celsius (104 to 106 degrees Fahrenheit), throughout the cavity while the patient lies on a cooling blanket to keep the body’s temperature at a safe level. The chemotherapy helps to kill any microscopic tumor cells that are left behind after the debulking surgery. Within one to two months, patients are often fully recovered from surgery and back to their regular activities.

Children’s Cancer Hospital • Summer 2010

Clinical trial for relapsed or refractory neuroblastoma For many children with recurrent or refractory cancer, the best options for treatment come in the form of clinical trials. Clinical trials are how new treatments are tested for safety and to see if they will be effective. MD Anderson Children’s Cancer Hospital has opened a new clinical trial for patients with relapsed or refractory neuroblastoma. Since for many of these patients chemotherapy is no longer effective alone, MD Anderson pediatric oncologists are trying a different approach using immune cells to fight the cancer. Everyone has a type of white blood cell, called natural killer cells, or NK cells. The job of an NK cell is to find an abnormal cell, a cell that’s infected with a virus or precancerous or cancer cell, seek it out and destroy it. Unfortunately for adults and children who have cancer, many times their immune system and their own NK cells can no longer recognize the cancer cells or kill them. In this clinical trial, Children’s Cancer Hospital oncologists plan to use NK cells taken from someone else, a family member or other relative, and see if they can be used to help the immune system fight the cancer. Another medicine called interleukin 2 will also be given. Interleukin 2 helps the NK cells grow, make more copies of themselves, and activates them so that they are better at killing cancer cells.

Faculty / Staff Accolades • Joya Chandra, Ph.D., has been elected to serve a two-year term on the Executive Committee of the Faculty Senate at MD Anderson. • The Children’s Cancer Hospital Award of Excellence in Family-Centered Care is awarded once per year to parents/ patients/staff/faculty who exhibit outstanding practice/support and mentoring of the concepts and philosophy of family-centered care. The faculty award was presented to Rhonda Robert, M.D. The Children’s Cancer Hospital Award of Excellence in FamilyCentered Care Award also was presented to parents Cip and Rhonda Cardenas, Missy Ramirez and Manale Elewah. • Alan Fields, M.D., received the Faculty Lifetime Achievement Award from the Society of Critical Care Medicine. • Dennis Hughes, M.D., Ph.D., was awarded an NIH-funded grant. • Christy Le, pediatrics department administrator in research, was the recipient of the March 2010 Heart of MD Anderson Award.

• Vivek Subbiah, M.D., received the Bayer Healthcare Pharmaceuticals, Inc. Award in Population/Patient-Oriented Research with his project titled “Of Mice and Men: Divergent Risks of Teriparatideinduced Osteosarcoma.” Subbiah also was the 2010 winner of the Daniel Benedict Gazan Fellowship in Sarcoma Research. To achieve this award, he was selected as the fellow demonstrating potential for excellence and unique contribution in sarcoma research. • Thuy Trinh, a child life specialist at the Children’s Cancer Hospital, was awarded the Sibling STAR Partner Certification from SuperSibs!, a national non-profit organization working to support brothers and sisters of children with cancer. The award honors outstanding professionals and programs in the pediatric oncology community making a difference in the lives of the often forgotten brothers and sisters of children with cancer.

• Patrick Zweidler-McKay, M.D., Ph.D., received two NCI grants. The first grant • Eugenie Kleinerman, M.D., head of the provides $207,500 in direct costs for the Children’s Cancer Hospital, has been named first year and $1,037,500 over five years by the Governor’s Commission as the 2010 with the major goal of mediating Outstanding Women in Texas Government cell-specific consequences of Notch Award winner in the category of Outstandsignaling in acute lymphoblastic ing Management. Kleinerman has earned an leukemia. The second grant provides international reputation for her sarcoma $130,500 in direct costs for this research and is the first female division two-year grant and concerns Notch in head at MD Anderson. neuroblastoma.

The side effects from this trial can include fevers, chills, flu-like symptoms and low blood counts. The principal investigator on this trial is Susan Kelly, M.D. To find out more about this clinical trial or any other trial at MD Anderson, or to speak with a pediatric oncologist about a child’s diagnosis, call the Patient Access Center for the Children’s Cancer Hospital at 713-792-5410 or call toll-free 888-543-2435.

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Camp Star Trails

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Camp Star Trails, an annual overnight camp for Children’s Cancer Hospital patients and their siblings ages 5-12, is all about having fun and being a normal kid in a normal setting.

The University of Texas MD Anderson Cancer Center • Division of Pediatrics

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New MD Anderson logo challenges employees, public to aspire to a world without cancer Mark visualizes institution’s Making Cancer History® tagline

T For only the fourth time in its 69-year history, The University of Texas MD Anderson Cancer Center has updated its logo, with a bold new look that symbolizes its mission: to eradicate cancer.

he logo integrates MD Anderson’s distinctive tagline, Making Cancer History, and the long-running cancer strike-through campaign, in which survivors tell their cancer stories and draw a red line through their cancer type to mark their triumph over the disease.

and care. Every patient and research finding teaches us more about how we can eliminate cancer,” says John Mendelsohn, M.D., president of MD Anderson. “This logo tells who we are and signifies that our efforts have a steadfast focus on the ultimate goal: Making Cancer History.”

The intent of the mark is to make clear to all those who touch MD Anderson the commitment to this mission and the optimism of being on the cusp of major advances towards reaching it.

“The red cancer strike through has proven to be one of the most powerful symbols of hope and inspiration to patients and their families and many have shared stories of how they dreamed of the day when they would star in an MD Anderson ad and strike out their disease with a red line for the world to see,” Mendelsohn says.

In addition, the new logo has been incorporated into the visual identities of all MD Anderson locations and relationships. MD Anderson Children’s Cancer Hospital and the Children’s Art Project have new logos reflecting the strike through, as do regional care centers and other collaborations in the United States and internationally. The updated logo is appearing in many venues, including on mdanderson.org, campus signs, institutional vehicles, print and online publications and in MD Anderson’s advertising campaigns. “We’re proud that we’ve created tremendous momentum in cancer research

The logo was created for MD Anderson by The Richards Group of Dallas, which has been its advertising agency since 1996.

“Our dream is that five years from now when people anywhere see a red strike through cancer, they will immediately associate it with MD Anderson and ‘Making Cancer History’,” Mendelsohn continues. “We want to be the first choice for patients and their families, for talented faculty and staff, for donors and volunteers whose support is essential and for students and trainees aspiring to be future leaders. With this new mark, we’ve told the world where we stand in the effort to end cancer so that they can come and stand with us.”