Clinical Focus


  • Pediatric Hematology-Oncology
  • Leukemia
  • Relapsed leukemia
  • Infectious complication of oncology treatment
  • Fungal infections

Academic Appointments


Honors & Awards


  • AOA, Medical Honor Society (2007)
  • Fellow, Rachleff Hem-Onc Pediatric Fellowship fund (2012-2013)

Professional Education


  • Board Certification: Pediatrics, American Board of Pediatrics (2010)
  • Board Certification: Pediatric Hematology-Oncology, American Board of Pediatrics (2015)
  • Medical Education:Tufts University School of Medicine (2007) MA
  • Residency:Massachusetts General HospitalMA
  • Internship:Massachusetts General HospitalMA
  • Fellowship:Lucile Packard Children's HospitalCA
  • Chief Resident, Massachusetts General Hospital for Children, Pediatrics (2011)
  • Resident, Massachusetts General Hospital for Children, Pediatrics (2010)
  • Doctor of Medicine, Tufts University School of Medicine (2007)

Current Research and Scholarly Interests


I am interested in the prevention and management of infectious complication in pediatric oncology patients. I am also interested in developing a protocol for the management of low risk patients with fever and neutropenia.

Clinical Trials


  • A Study of Venetoclax in Combination With Navitoclax and Chemotherapy in Subjects With Relapsed/Refractory Acute Lymphoblastic Leukemia or Relapsed/Refractory Lymphoblastic Lymphoma Recruiting

    This dose-escalating study is to determine the safety, pharmacokinetics, and preliminary efficacy of venetoclax in combination with navitoclax and chemotherapy in adult and pediatric participants with relapsed/refractory acute lymphoblastic leukemia (ALL) or relapsed/refractory lymphoblastic lymphoma.

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  • CD19/CD22 Chimeric Antigen Receptor T Cells and Chemotherapy in Treating Children or Young Adults With Recurrent or Refractory CD19 Positive B Acute Lymphoblastic Leukemia Recruiting

    This phase I trial studies the best dose and side effects of CD19/CD22 chimeric antigen receptor (CAR) T cells when given together with chemotherapy, and to see how well they work in treating children or young adults with CD19 positive B acute lymphoblastic leukemia that has come back or does not respond to treatment. A CAR is a genetically-engineered receptor made so that immune cells (T cells) can attack cancer cells by recognizing and responding to the CD19/CD22 proteins. These proteins are commonly found on B acute lymphoblastic leukemia. Drugs used in chemotherapy, such as fludarabine phosphate and cyclophosphamide, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving CD19/CD22-CAR T cells and chemotherapy may work better in treating children or young adults with B acute lymphoblastic leukemia.

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  • Home Away From Home - Quality of Life Surveys Recruiting

    Treatment for pediatric acute myeloid leukemia (AML) involves intensive chemotherapy regimens that result in periods of profound neutropenia leaving patients susceptible to severe infectious complications. Infectious complications are the leading cause of treatment related mortality among AML patients, but there are little clinical data to inform whether management of neutropenia post AML chemotherapy should occur in an outpatient or inpatient setting. Further, no studies have been conducted that assess the impact of neutropenia management strategy on the quality of life of pediatric patients with AML and their caregivers.

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All Publications


  • Identifying patient- and family-centered outcomes relevant to inpatient versus at-home management of neutropenia in children with acute myeloid leukemia PEDIATRIC BLOOD & CANCER Szymczak, J. E., Getz, K. D., Madding, R., Fisher, B., Raetz, E., Hijiya, N., Gramatges, M. M., Henry, M., Mian, A., Arnold, S. D., Aftandilian, C., Collier, A. B., Aplenc, R. 2018; 65 (4)

    View details for DOI 10.1002/pbc.26927

    View details for Web of Science ID 000425642100028

  • Multisite external validation of a risk prediction model for the diagnosis of blood stream infections in febrile pediatric oncology patients without severe neutropenia. Cancer Esbenshade, A. J., Zhao, Z., Aftandilian, C., Saab, R., Wattier, R. L., Beauchemin, M., Miller, T. P., Wilkes, J. J., Kelly, M. J., Fernbach, A., Jeng, M., Schwartz, C. L., Dvorak, C. C., Shyr, Y., Moons, K. G., Sulis, M., Friedman, D. L. 2017

    Abstract

    Pediatric oncology patients are at an increased risk of invasive bacterial infection due to immunosuppression. The risk of such infection in the absence of severe neutropenia (absolute neutrophil count ≥ 500/μL) is not well established and a validated prediction model for blood stream infection (BSI) risk offers clinical usefulness.A 6-site retrospective external validation was conducted using a previously published risk prediction model for BSI in febrile pediatric oncology patients without severe neutropenia: the Esbenshade/Vanderbilt (EsVan) model. A reduced model (EsVan2) excluding 2 less clinically reliable variables also was created using the initial EsVan model derivative cohort, and was validated using all 5 external validation cohorts. One data set was used only in sensitivity analyses due to missing some variables.From the 5 primary data sets, there were a total of 1197 febrile episodes and 76 episodes of bacteremia. The overall C statistic for predicting bacteremia was 0.695, with a calibration slope of 0.50 for the original model and a calibration slope of 1.0 when recalibration was applied to the model. The model performed better in predicting high-risk bacteremia (gram-negative or Staphylococcus aureus infection) versus BSI alone, with a C statistic of 0.801 and a calibration slope of 0.65. The EsVan2 model outperformed the EsVan model across data sets with a C statistic of 0.733 for predicting BSI and a C statistic of 0.841 for high-risk BSI.The results of this external validation demonstrated that the EsVan and EsVan2 models are able to predict BSI across multiple performance sites and, once validated and implemented prospectively, could assist in decision making in clinical practice. Cancer 2017. © 2017 American Cancer Society.

    View details for DOI 10.1002/cncr.30792

    View details for PubMedID 28542918

  • Pediatric Oncology Discharges With Febrile Neutropenia: Variation in Location of Care JOURNAL OF PEDIATRIC HEMATOLOGY ONCOLOGY Alvarez, E., Chamberlain, L. J., Aftandilian, C., Saynina, O., Wise, P. 2017; 39 (1): E1-E7

    Abstract

    We examined the use of Pediatric Cancer Specialty Centers (PCSCs) over time and the length of stay (LOS) in pediatric oncology patients with a diagnosis of febrile neutropenia. PCSCs were defined as Children's Oncology Group and California Children's Services designated centers. We performed a retrospective analysis on all discharges of pediatric (0 to 18) oncology patients with febrile neutropenia in California (1983 to 2011) using the private Office of Statewide Health Planning and Development database. We examined influence of age, sex, race/ethnicity, payer, income, distance, tumor type, and complications on utilization of PCSCs and LOS (SAS 9.2). Analysis of 24,559 pediatric oncology febrile neutropenia discharges showed hospitalizations in PCSCs increasing from 48% in 1983 to 94% in 2011. The adjusted regression analysis showed decreased PCSC utilization for ages 15 to 18, Hispanic patients, and those living >40 miles away. The median PCSC LOS was 9 days compared with 7 days at a non-PCSC (P<0.0001). Discharge from a PCSC was associated with a LOS >8 days after controlling for complications. Inpatient PCSC care for febrile neutropenia in California has increased since 1983. Receiving care at a PCSC is influenced by age, tumor type, ethnicity, geography, and complications.

    View details for DOI 10.1097/MPH.0000000000000716

    View details for Web of Science ID 000391634100001

    View details for PubMedID 27918351

  • Invasive Fungal Disease in Pediatric Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplant JOURNAL OF PEDIATRIC HEMATOLOGY ONCOLOGY Aftandilian, C., Weinberg, K., Willert, J., Kharbanda, S., Porteus, M., Maldonado, Y., Agarwal, R. 2016; 38 (7): 574-580
  • Evaluation of Febrile, Nonneutropenic Pediatric Oncology Patients with Central Venous Catheters Who Are Not Given Empiric Antibiotics JOURNAL OF PEDIATRICS Bartholomew, F., Aftandilian, C., Andrews, J., Gutierrez, K., Luna-Fineman, S., Jeng, M. 2015; 166 (1): 157-162

    Abstract

    To evaluate the practice of empiric antibiotics for febrile, nonneutropenic pediatric oncology patients with a central venous catheter (CVC) in place.Episodes of fever without neutropenia (absolute neutrophil count [ANC] ≥500 cells/mm(3)) were reviewed retrospectively in pediatric oncology patients with a CVC undergoing chemotherapy. Characteristics and symptoms were compared between patients with bacteremia and patients without bacteremia.A total of 392 episodes of nonneutropenic fever in 138 subjects (52 females; 38%) were reviewed. In this cohort, the median age at an episode was 7 years, and the majority of patients had a diagnosis of acute leukemia (54%). Median ANC was 3100 cells/mm(3) (IQR, 1570-5980 cells/mm(3)). Median temperature was 38.7°C (IQR, 38.3-39.2°C). Twenty-four infectious episodes (6%) occurred in 18 subjects, and 5 CVCs required removal; all patients requiring removal admitted and received antibiotics owing to chills. There were no significant difference in age, sex, or ANC between patients with bacteremia and those without bacteremia; however, mean temperature was higher in the patients with bacteremia (39.4°C vs 38.7°C; P = .003). No deaths due to sepsis occurred, and no CVCs were removed because antibiotics were not administered empirically.Our practice of observing pediatric oncology patients undergoing chemotherapy with CVCs who are not neutropenic does not appear to lead to increased serious adverse outcomes and avoids antibiotic exposure for >90% of patients without a bacterial infection.

    View details for DOI 10.1016/j.jpeds.2014.09.008

    View details for Web of Science ID 000346584000032

    View details for PubMedID 25444524

  • The Neutropenic Diet ... Still Ageless? C. Aftandilian Article Reviewed ONCOLOGY-NEW YORK Aftandilian, C. C., Milotich, C., Sakamoto, K. M. 2012; 26 (6): 586-589
  • The neutropenic diet... still ageless? Oncology (Williston Park, N.Y.) Aftandilian, C. C., Milotich, C., Sakamoto, K. M. 2012; 26 (6): 586-?

    View details for PubMedID 22870544

  • Burkitt Lymphoma With Pancreatic Involvement JOURNAL OF PEDIATRIC HEMATOLOGY ONCOLOGY Aftandilian, C. C., Friedmann, A. M. 2010; 32 (8): E338-E340

    Abstract

    A 10-year-old boy was referred to our clinic for tonsillectomy and was found to have a large mass within his oropharynx. Intraoperative biopsies confirmed Burkitt lymphoma. Further imaging and biopsy revealed pancreatic involvement. He was treated with multiagent chemotherapy. He remains disease-free 6 years later. Review of the literature demonstrates other cases of non-Hodgkin lymphoma with pancreatic involvement with good outcomes. Pancreatic involvement is a relatively rare occurrence in childhood lymphoma.

    View details for DOI 10.1097/MPH.0b013e3181ed1178

    View details for Web of Science ID 000283538300021

    View details for PubMedID 20930650

  • Group therapy for substance use disorders: What do we know? HARVARD REVIEW OF PSYCHIATRY Weiss, R. D., Jaffee, W. B., de Menil, V. P., Cogley, C. B. 2004; 12 (6): 339-350

    Abstract

    Although group therapy is the most prevalent treatment modality for substance use disorders, an up-to-date review of treatment outcome literature does not exist. A search of the literature yielded 24 treatment outcome studies comparing group therapy to other treatment conditions. These studies fell into one of six research design categories: (1) group therapy versus no group therapy; (2) group therapy versus individual therapy; (3) group therapy plus individual therapy versus group therapy alone; (4) group therapy plus individual therapy versus individual therapy alone; (5) group therapy versus another group therapy with different content or theoretical orientation; and (6) more group therapy versus less group therapy. In general, treatment outcome studies did not demonstrate differences between group and individual modalities, and no single type of group therapy reliably demonstrated greater efficacy than others. Unique methodological and logistical hurdles encountered in research on group therapy for substance use disorders, as well as considerations for future research, are also discussed.

    View details for DOI 10.1080/1067322049095723

    View details for Web of Science ID 000226593100004

    View details for PubMedID 15764469

  • Requiring remission of undue influence of weight and shape on self-evaluation in the definition of recovery for bulimia nervosa Annual Conference of the Academy-for-Eating-Disorders Cogley, C. B., Keel, P. K. JOHN WILEY & SONS INC. 2003: 200–210

    Abstract

    The current study evaluated the concurrent validity of requiring remission of undue influence of weight and shape on self-evaluation (undue influence) in defining recovery from bulimia nervosa (BN).Three groups completed the Beck Depression Inventory, the Mood and Anxiety Symptom Questionnaire, the Body Shape Questionnaire, and the Social Adjustment Scale: 31 women were fully recovered from BN (FR), 28 women had no behavioral symptoms of BN (partially recovered [PR]), and 59 matched non-eating-disordered controls (MC).The PR group had more pathologic scores on depression, anxiety, body dissatisfaction, and social adjustment compared with both the FR and MC groups, which did not differ from each other.These findings suggest that including remission of cognitive symptoms in a standardized definition of recovery may prove to be clinically useful in establishing reliable prognostic indicators. Future research should evaluate the role played by cognitive symptoms in triggering relapse.

    View details for DOI 10.1002/eat.10187

    View details for Web of Science ID 000184510900003

    View details for PubMedID 12898556