{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:21:38Z","timestamp":1785435698024,"version":"3.56.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2023,4,6]],"date-time":"2023-04-06T00:00:00Z","timestamp":1680739200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,4,6]],"date-time":"2023-04-06T00:00:00Z","timestamp":1680739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100010092","name":"Hannah's Heroes Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010092","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Childs Nerv Syst"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>To describe disease outcomes including overall survival and relapse patterns by subgroup in young pediatric patients treated for medulloblastoma with a radiation-sparing approach.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Retrospective analysis of clinical outcomes includes treatment, relapse, and salvage therapy and late effects in children treated for medulloblastoma with a radiation-sparing approach at British Columbia Children\u2019s Hospital (BCCH) between 2000 and 2020.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>There were 30 patients (median age 2.8\u00a0years, 60% male) treated for medulloblastoma with a radiation-sparing approach at BCCH. Subgroups included Sonic Hedgehog (SHH) (<jats:italic>n<\/jats:italic>\u2009=\u200914), group 3 (<jats:italic>n<\/jats:italic>\u2009=\u20097), group 4 (<jats:italic>n<\/jats:italic>\u2009=\u20096), and indeterminate status (<jats:italic>n<\/jats:italic>\u2009=\u20093). Three- and 5-year event-free survival (EFS) were 49.0% (30.2\u201365.4%) and 42.0% (24.2\u201358.9%)\u00a0and overall survival (OS)\u00a066.0% (95% CI 46.0\u201380.1%) and 62.5% (95% CI 42.5 and 77.2%), respectively, with a median follow-up of 9.5\u00a0years. Relapse occurred in 12\/25 patients following a complete response, of whom six (group 4: <jats:italic>n<\/jats:italic>\u2009=\u20094; group 3: <jats:italic>n<\/jats:italic>\u2009=\u20091; unknown: <jats:italic>n<\/jats:italic>\u2009=\u20091) were successfully salvaged with craniospinal axis (CSA) RT and remain alive at a median follow-up of 7\u00a0years. Disease\/treatment-related morbidity included endocrinopathies (<jats:italic>n<\/jats:italic>\u2009=\u20098), hearing loss <jats:italic>n<\/jats:italic>\u2009=\u200916), and neurocognitive abnormalities (<jats:italic>n<\/jats:italic>\u2009=\u20099).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This radiation sparing treatment approach for young patients with medulloblastoma resulted in a durable cure in most patients with SHH subgroup medulloblastoma. In those patients with groups 3 and 4 medulloblastoma, relapse rates were high; however, most group 4 patients were salvaged with RT.\n<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00381-023-05918-z","type":"journal-article","created":{"date-parts":[[2023,4,6]],"date-time":"2023-04-06T11:02:48Z","timestamp":1680778968000},"page":"2095-2104","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Outcomes of a radiation sparing approach in medulloblastoma by subgroup in young children: an institutional review"],"prefix":"10.1007","volume":"39","author":[{"given":"Rebecca","family":"Ronsley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Triscott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Stanek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Rod","family":"Rassekh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Lum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Goddard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dina","family":"McConnell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caron","family":"Strahlendorf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ash","family":"Singhal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan L.","family":"Finlay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Yip","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Dunham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliette","family":"Hukin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,4,6]]},"reference":[{"issue":"4","key":"5918_CR1","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1634\/theoncologist.2008-0193","volume":"14","author":"L Lafay-Cousin","year":"2009","unstructured":"Lafay-Cousin L, Strother D (2009) Current treatment approaches for infants with malignant central nervous system tumors. Oncologist 14(4):433\u2013444","journal-title":"Oncologist"},{"key":"5918_CR2","doi-asserted-by":"crossref","unstructured":"Stavinoha\u00a0PL, Askins\u00a0MA, Powell\u00a0SK, Pillay Smiley\u00a0N, Robert\u00a0RS (2018) Neurocognitive and psychosocial outcomes in pediatric brain tumor survivors. Bioengineering (Basel) 5(3)","DOI":"10.3390\/bioengineering5030073"},{"issue":"1","key":"5918_CR3","first-page":"31","volume":"53","author":"BH Cohen","year":"2015","unstructured":"Cohen BH, Geyer JR, Miller DC, Curran JG, Zhou T, Holmes E, Ingles SA, Dunkel IJ, Hilden J, Packer RJ, Pollack IF, Gajjar A, Finlay JL (2015) Pilot study of intensive chemotherapy with peripheral hematopoietic cell support for children less than 3 years of age with malignant brain tumors, the CCG-99703 phase I\/II study. A Report From the Children\u2019s Oncology Group, Pediatr Neurol 53(1):31\u201346","journal-title":"A Report From the Children\u2019s Oncology Group, Pediatr Neurol"},{"issue":"6","key":"5918_CR4","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1002\/pbc.21525","volume":"50","author":"G Dhall","year":"2008","unstructured":"Dhall G, Grodman H, Ji L, Sands S, Gardner S, Dunkel IJ, McCowage GB, Diez B, Allen JC, Gopalan A, Cornelius AS, Termuhlen A, Abromowitch M, Sposto R, Finlay JL (2008) Outcome of children less than three years old at diagnosis with non-metastatic medulloblastoma treated with chemotherapy on the \u201cHead Start\u201d I and II protocols. Pediatr Blood Cancer 50(6):1169\u20131175","journal-title":"Pediatr Blood Cancer"},{"issue":"11","key":"5918_CR5","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1038\/sj.bmt.1705162","volume":"36","author":"D Valteau-Couanet","year":"2005","unstructured":"Valteau-Couanet D, Fillipini B, Benhamou E, Grill J, Kalifa C, Couanet D, Habrand JL, Hartmann O (2005) High-dose busulfan and thiotepa followed by autologous stem cell transplantation (ASCT) in previously irradiated medulloblastoma patients: high toxicity and lack of efficacy. Bone Marrow Transplant 36(11):939\u2013945","journal-title":"Bone Marrow Transplant"},{"issue":"3","key":"5918_CR6","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1002\/pbc.20781","volume":"48","author":"HK Thorarinsdottir","year":"2007","unstructured":"Thorarinsdottir HK, Rood B, Kamani N, Lafond D, Perez-Albuerne E, Loechelt B, Packer RJ, MacDonald TJ (2007) Outcome for children <4 years of age with malignant central nervous system tumors treated with high-dose chemotherapy and autologous stem cell rescue. Pediatr Blood Cancer 48(3):278\u2013284","journal-title":"Pediatr Blood Cancer"},{"issue":"9","key":"5918_CR7","doi-asserted-by":"publisher","first-page":"1527","DOI":"10.1002\/pbc.26042","volume":"63","author":"L Lafay-Cousin","year":"2016","unstructured":"Lafay-Cousin L, Smith A, Chi SN, Wells E, Madden J, Margol A, Ramaswamy V, Finlay J, Taylor MD, Dhall G, Strother D, Kieran MW, Foreman NK, Packer RJ, Bouffet E (2016) Clinical, pathological, and molecular characterization of infant medulloblastomas treated with sequential high-dose chemotherapy. Pediatr Blood Cancer 63(9):1527\u20131534","journal-title":"Pediatr Blood Cancer"},{"issue":"3","key":"5918_CR8","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1200\/JCO.19.00845","volume":"38","author":"L Lafay-Cousin","year":"2020","unstructured":"Lafay-Cousin L, Bouffet E, Strother D, Rudneva V, Hawkins C, Eberhart C, Horbinski C, Heier L, Souweidane M, Williams-Hughes C, Onar-Thomas A, Billups CA, Fouladi M, Northcott P, Robinson G, Gajjar A (2020) Phase II study of nonmetastatic desmoplastic medulloblastoma in children younger than 4 years of age: a report of the Children\u2019s Oncology Group (ACNS1221). J Clin Oncol 38(3):223\u2013231","journal-title":"J Clin Oncol"},{"issue":"6","key":"5918_CR9","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1016\/S1470-2045(18)30204-3","volume":"19","author":"GW Robinson","year":"2018","unstructured":"Robinson GW, Rudneva VA, Buchhalter I, Billups CA, Waszak SM, Smith KS, Bowers DC, Bendel A, Fisher PG, Partap S, Crawford JR, Hassall T, Indelicato DJ, Boop F, Klimo P, Sabin ND, Patay Z, Merchant TE, Stewart CF, Orr BA, Korbel JO, Jones DTW, Sharma T, Lichter P, Kool M, Korshunov A, Pfister SM, Gilbertson RJ, Sanders RP, Onar-Thomas A, Ellison DW, Gajjar A, Northcott PA (2018) Risk-adapted therapy for young children with medulloblastoma (SJYC07): therapeutic and molecular outcomes from a multicentre, phase 2 trial. Lancet Oncol 19(6):768\u2013784","journal-title":"Lancet Oncol"},{"issue":"26","key":"5918_CR10","doi-asserted-by":"publisher","first-page":"3181","DOI":"10.1200\/JCO.2010.34.4341","volume":"30","author":"DM Ashley","year":"2012","unstructured":"Ashley DM, Merchant TE, Strother D, Zhou T, Duffner P, Burger PC, Miller DC, Lyon N, Bonner MJ, Msall M, Buxton A, Geyer R, Kun LE, Coleman L, Pollack IF (2012) Induction chemotherapy and conformal radiation therapy for very young children with nonmetastatic medulloblastoma: Children\u2019s Oncology Group study P9934. J Clin Oncol 30(26):3181\u20133186","journal-title":"J Clin Oncol"},{"issue":"1","key":"5918_CR11","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.ejca.2009.09.013","volume":"46","author":"RG Grundy","year":"2010","unstructured":"Grundy RG, Wilne SH, Robinson KJ, Ironside JW, Cox T, Chong WK, Michalski A, Campbell RH, Bailey CC, Thorp N, Pizer B, Punt J, Walker DA, Ellison DW, Machin D (2010) Primary postoperative chemotherapy without radiotherapy for treatment of brain tumours other than ependymoma in children under 3 years: results of the first UKCCSG\/SIOP CNS 9204 trial. Eur J Cancer 46(1):120\u2013133","journal-title":"Eur J Cancer"},{"issue":"8","key":"5918_CR12","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1016\/S1470-2045(05)70252-7","volume":"6","author":"J Grill","year":"2005","unstructured":"Grill J, Sainte-Rose C, Jouvet A, Gentet JC, Lejars O, Frappaz D, Doz F, Rialland X, Pichon F, Bertozzi AI, Chastagner P, Couanet D, Habrand JL, Raquin MA, Le Deley MC, Kalifa C (2005) Treatment of medulloblastoma with postoperative chemotherapy alone: an SFOP prospective trial in young children. Lancet Oncol 6(8):573\u2013580","journal-title":"Lancet Oncol"},{"issue":"30","key":"5918_CR13","doi-asserted-by":"publisher","first-page":"7621","DOI":"10.1200\/JCO.2005.09.095","volume":"23","author":"JR Geyer","year":"2005","unstructured":"Geyer JR, Sposto R, Jennings M, Boyett JM, Axtell RA, Breiger D, Broxson E, Donahue B, Finlay JL, Goldwein JW, Heier LA, Johnson D, Mazewski C, Miller DC, Packer R, Puccetti D, Radcliffe J, Tao ML, Shiminski-Maher T (2005) Multiagent chemotherapy and deferred radiotherapy in infants with malignant brain tumors: a report from the Children\u2019s Cancer Group. J Clin Oncol 23(30):7621\u20137631","journal-title":"J Clin Oncol"},{"issue":"24","key":"5918_CR14","doi-asserted-by":"publisher","first-page":"4881","DOI":"10.1200\/JCO.2004.12.126","volume":"22","author":"SN Chi","year":"2004","unstructured":"Chi SN, Gardner SL, Levy AS, Knopp EA, Miller DC, Wisoff JH, Weiner HL, Finlay JL (2004) Feasibility and response to induction chemotherapy intensified with high-dose methotrexate for young children with newly diagnosed high-risk disseminated medulloblastoma. J Clin Oncol 22(24):4881\u20134887","journal-title":"J Clin Oncol"},{"issue":"10","key":"5918_CR15","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1056\/NEJMoa042176","volume":"352","author":"S Rutkowski","year":"2005","unstructured":"Rutkowski S, Bode U, Deinlein F, Ottensmeier H, Warmuth-Metz M, Soerensen N, Graf N, Emser A, Pietsch T, Wolff JE, Kortmann RD, Kuehl J (2005) Treatment of early childhood medulloblastoma by postoperative chemotherapy alone. N Engl J Med 352(10):978\u2013986","journal-title":"N Engl J Med"},{"issue":"12","key":"5918_CR16","doi-asserted-by":"publisher","first-page":"1862","DOI":"10.1093\/neuonc\/noaa102","volume":"22","author":"G Dhall","year":"2020","unstructured":"Dhall G, O\u2019Neil SH, Ji L, Haley K, Whitaker AM, Nelson MD, Gilles F, Gardner SL, Allen JC, Cornelius AS, Pradhan K, Garvin JH, Olshefski RS, Hukin J, Comito M, Goldman S, Atlas MP, Walter AW, Sands S, Sposto R, Finlay JL (2020) Excellent outcome of young children with nodular desmoplastic medulloblastoma treated on \u201cHead Start\u201d III: a multi-institutional, prospective clinical trial. Neuro Oncol 22(12):1862\u20131872","journal-title":"Neuro Oncol"},{"issue":"12","key":"5918_CR17","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1093\/neuonc\/noaa122","volume":"22","author":"LV Baroni","year":"2020","unstructured":"Baroni LV, Sampor C, Gonzalez A, Lubieniecki F, Lamas G, Rugilo C, Bartels U, Heled A, Smith KS, Northcott PA, Bouffet E, Alderete D, Ramaswamy V (2020) Bridging the treatment gap in infant medulloblastoma: molecularly informed outcomes of a globally feasible regimen. Neuro Oncol 22(12):1873\u20131881","journal-title":"Neuro Oncol"},{"issue":"4","key":"5918_CR18","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1007\/s00401-011-0899-7","volume":"123","author":"PA Northcott","year":"2012","unstructured":"Northcott PA, Shih DJ, Remke M, Cho YJ, Kool M, Hawkins C, Eberhart CG, Dubuc A, Guettouche T, Cardentey Y, Bouffet E, Pomeroy SL, Marra M, Malkin D, Rutka JT, Korshunov A, Pfister S, Taylor MD (2012) Rapid, reliable, and reproducible molecular sub-grouping of clinical medulloblastoma samples. Acta Neuropathol 123(4):615\u2013626","journal-title":"Acta Neuropathol"},{"issue":"4","key":"5918_CR19","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1177\/10935266211001986","volume":"24","author":"J Triscott","year":"2021","unstructured":"Triscott J, Yip S, Johnston D, Michaud J, Rassekh SR, Hukin J, Dunn S, Dunham C (2021) Histologic correlates of molecular group 4 pediatric medulloblastoma: a retrospective Canadian review. Pediatr Dev Pathol 24(4):309\u2013317","journal-title":"Pediatr Dev Pathol"},{"issue":"22","key":"5918_CR20","doi-asserted-by":"publisher","first-page":"6734","DOI":"10.1158\/0008-5472.CAN-12-4331","volume":"73","author":"J Triscott","year":"2013","unstructured":"Triscott J, Lee C, Foster C, Manoranjan B, Pambid MR, Berns R, Fotovati A, Venugopal C, O\u2019Halloran K, Narendran A, Hawkins C, Ramaswamy V, Bouffet E, Taylor MD, Singhal A, Hukin J, Rassekh R, Yip S, Northcott P, Singh SK, Dunham C, Dunn SE (2013) Personalizing the treatment of pediatric medulloblastoma: polo-like kinase 1 as a molecular target in high-risk children. Cancer Res 73(22):6734\u20136744","journal-title":"Cancer Res"},{"issue":"3","key":"5918_CR21","first-page":"329","volume":"7","author":"SH O'Neil","year":"2020","unstructured":"O\u2019Neil SH, Whitaker AM, Kayser K, Nelson MB, Finlay JL, Dhall G, Sands S (2020) Neuropsychological outcomes on Head Start III: a prospective, multi-institutional clinical trial for young children diagnosed with malignant brain tumors. Neurooncol Pract 7(3):329\u2013337","journal-title":"Neurooncol Pract"},{"issue":"2","key":"5918_CR22","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1007\/s11060-013-1111-9","volume":"113","author":"R Venkatramani","year":"2013","unstructured":"Venkatramani R, Ji L, Lasky J, Haley K, Judkins A, Zhou S, Sposto R, Olshefski R, Garvin J, Tekautz T, Kennedy G, Rassekh SR, Moore T, Gardner S, Allen J, Shore R, Moertel C, Atlas M, Dhall G, Finlay J (2013) Outcome of infants and young children with newly diagnosed ependymoma treated on the \u201cHead Start\u201d III prospective clinical trial. J Neurooncol 113(2):285\u2013291","journal-title":"J Neurooncol"},{"issue":"4","key":"5918_CR23","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1002\/pbc.24830","volume":"61","author":"JK Bass","year":"2014","unstructured":"Bass JK, Huang J, Onar-Thomas A, Chang KW, Bhagat SP, Chintagumpala M, Bartels U, Gururangan S, Hassall T, Heath JA, McCowage G, Cohn RJ, Fisher MJ, Robinson G, Broniscer A, Gajjar A, Gurney JG (2014) Concordance between the Chang and the International Society of Pediatric Oncology (SIOP) ototoxicity grading scales in patients treated with cisplatin for medulloblastoma. Pediatr Blood Cancer 61(4):601\u2013605","journal-title":"Pediatr Blood Cancer"},{"issue":"9","key":"5918_CR24","doi-asserted-by":"publisher","first-page":"1644","DOI":"10.1002\/pbc.25064","volume":"61","author":"A Saha","year":"2014","unstructured":"Saha A, Salley CG, Saigal P, Rolnitzky L, Goldberg J, Scott S, Olshefski R, Hukin J, Sands SA, Finlay J, Gardner SL (2014) Late effects in survivors of childhood CNS tumors treated on Head Start I and II protocols. Pediatr Blood Cancer 61(9):1644\u20131672","journal-title":"Pediatr Blood Cancer"},{"key":"5918_CR25","doi-asserted-by":"crossref","unstructured":"Cochrane\u00a0AM, Cheung\u00a0C, Rangan\u00a0K, Freyer\u00a0D, Nahata\u00a0L, Dhall\u00a0G, Finlay\u00a0JL (2017) Long-term follow-up of endocrine function among young children with newly diagnosed malignant central nervous system tumors treated with irradiation-avoiding regimens. Pediatr Blood Cancer 64(11)","DOI":"10.1002\/pbc.26616"}],"container-title":["Child's Nervous System"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00381-023-05918-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00381-023-05918-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00381-023-05918-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T13:07:21Z","timestamp":1690808841000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00381-023-05918-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,6]]},"references-count":25,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["5918"],"URL":"https:\/\/doi.org\/10.1007\/s00381-023-05918-z","relation":{},"ISSN":["0256-7040","1433-0350"],"issn-type":[{"value":"0256-7040","type":"print"},{"value":"1433-0350","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,6]]},"assertion":[{"value":"4 October 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 March 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 April 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This project was reviewed and approved by the British Columbia Children\u2019s Hospital and University of British Columbia institutional review boards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"SY is a member of advisory boards of Amgen, AstraZeneca, Bayer, Incyte, Roche. JH is a member of advisory boards for AstraZeneca and Novartis. Otherwise, the authors have no conflicts of interest, financial or otherwise, to disclose.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}