How Texas Children’s Cancer and Hematology Center Works to Understand the Causes and Consequences of Pediatric Cancer Through Its Epidemiology and Population Sciences Program

According to the National Cancer Institute (NCI), more than 15,000 cases of pediatric cancer will be diagnosed in the United States this year — a number that’s been consistently increasing for the last several decades. For Philip Lupo, PhD, MPH, director of the Epidemiology and Population Sciences Program at Texas Children’s Cancer and Hematology Center, determining who is affected and why are chief among the questions he and his team are working diligently to answer. 

As one of the few cancer centers in the country with a dedicated epidemiology and population sciences program, Dr. Lupo is excited by the opportunities that arise through collaboration with other Texas Children’s Cancer and Hematology Center faculty.  

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“Our ability to work directly with clinicians and other scientists across the cancer and hematology center is unique,” said Dr. Lupo, who also serves as Chair of the Children’s Oncology Group (COG) Epidemiology Committee. “We can develop studies and analyze trends based on clinical observations to help us determine why children get cancer, what happens during therapy and what happens to survivors as a consequence of their cancer or its therapy.” 

Not only does the program’s home in the cancer and hematology center enable the team to see the results of their research in action, Texas Children’s Hospital’s physical location in Houston, Texas, also provides a unique opportunity for inclusivity — the diverse population ensures children of all races and ethnicities are well-represented in their research.  

4 key areas of focus 

Dedicated to studying the distribution and determinants of childhood cancer, Dr. Lupo’s team of 12 faculty and 50+ staff members focus on 4 key specialty areas: 

1. Genetic susceptibility 
2. Health disparities 
3. Environmental risk 
4. Toxicities/late effects 

The program, which was founded more than 20 years ago, is also prolific, with $20 million in grant funding and more than 50 publications in the past year. 

“Part of our mission is to provide professional and public education,” Dr. Lupo said. “In addition to sharing findings through scientific journals, we train clinical fellows in methods to develop their own research as well as graduate students at Baylor College of Medicine who work in our lab. We participate in local and national community outreach efforts, including the Childhood Cancer Data Initiative — an NCI-supported effort to build a community centered on childhood cancer care and research data.”  

Genetic susceptibility research  

One area of active research focuses on genetic susceptibility to pediatric cancer, and an example of this work is focused on acute lymphoblastic leukemia (ALL) predisposition in children with Down syndrome. Notably, children who have Down syndrome are 10 to 20 times more likely to develop leukemia compared to those without this congenital condition, however, the reasons are unclear. The Epidemiology and Population Sciences Program is addressing this important outcome. 

“For instance, in a recent report, we looked for genetic variants that predispose children with Down syndrome to developing leukemia in childhood,” Dr. Lupo said. “We found four genetic variants that were strongly associated with leukemia risk in children with Down syndrome. While these genes had been previously identified in previous studies, the effects were much stronger in children with Down syndrome.” 

The findings, which were published in the journal Blood, serve as the framework for new assessments with the goal of improving our understanding of Down syndrome-associated leukemia and has led to a new study funded by the NCI to further explore the role of genetics on leukemia risk in children with Down syndrome. 

Health disparities 

Another of the team’s key focuses is on addressing health disparities among children with cancer. To that end, the team has received grants from St. Baldrick’s Foundation and the NCI to study disparities among Latino children and adolescents with ALL, to develop the foundation for the first Specialized Programs of Research Excellence (SPORE) devoted to pediatric leukemia. The research, led by Dr. Lupo and Karen Rabin, MD, PhD, director of the Leukemia Program at Texas Children’s Hospital, include 6 cancer centers across the United States that have provided clinical data, as well as bone marrow, blood and cerebrospinal fluid samples from nearly 2,000 children and adolescents with leukemia. 

Environmental risk 

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The team recently onboarded Thanh Hoang, PhD, who specializes in the intersection of environmental health and molecular biology. During her postdoctoral fellowship, she gained expertise in examining how environmental toxicants impact epigenetics, i.e., the way cells control gene activity without changes to the cells’ DNA. These studies will ultimately provide us with tools to evaluate the interplay between environmental exposures and genetic susceptibility on the risk of developing and treating pediatric cancer.  

Toxicities in therapy/late effects 

The team also works closely with Texas Children’s Long-Term Survivor Program, which monitors more than 2,000 patients for delayed side effects and complications caused by their previous cancer and cancer therapies. Though relatively rare, these “late” effects are potentially serious and often difficult to diagnose. The program is one of only a few pediatric programs in the U.S. to provide care throughout a patient’s lifetime and to see patients who were treated at any pediatric cancer treatment center. 

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Through the Long-Term Survivor Program, Michael Scheurer, PhD, MPH, FACE, member and former director of the Epidemiology and Population Sciences Program; Monica Gramatges, MD, PhD, co-director, Long-Term Survivor Program; and Lisa Kahalley, PhD, director of Neurobehavioral Oncology, are leading an NCI-funded health disparities initiative entitled, “Survivorship and Access to care for Latinos to Understand and address Disparities (SALUD)” that is designed to characterize late effects in Latino survivors of childhood cancer. 

The ultimate purpose of ongoing research is to develop successful interventions for survivors with late complications, as well as to design future cancer therapies that are not associated with late adverse effects. 

Seeking collaboration 

To achieve its goals, collaboration is key to gathering the necessary data. 

“We don’t just say we value collaboration — it’s vital to our work,” Dr. Lupo said. “We’re interested in working with clinicians and other scientists to develop new and expand existing projects. This includes building consortia, particularly in smaller geographies and historically excluded areas. Our ultimate goal is to address disparities in susceptibility and outcomes through our research.” 

Learn more about the Epidemiology and Population Sciences Program at Texas Children’s Hospital or contact epicenter@bcm.edu to explore potential opportunities for collaboration.