Table 1.

Suggested Treatment Modifications and Supportive Care Recommendations for A-T Patients Receiving Cancer Therapy.

Medical vulnerability	Treatment Modification	Supportive care
1) Increased sensitivity to ionizing radiation and radiomimetics	Avoid/limit dose of radiation and radiomimetics (e.g., bleomycin)	Use diagnostic x-rays as needed for state of the art medical care. Consider use of alternate imaging modalities (e.g. ultrasonography, magnetic resonance imaging).
2) Mucosal damage/repair leading to telangiectasias and late onset bleeding:
a) Late onset hemorrhagic cystitis from cyclophosphamide and ifosfamide	Administer Mesna with all doses of these agents	Provide aggressive hydration with all doses of these agents
b) Late onset GI bleeding post Mucositis		Optimize methotrexate clearance. Avoid concurrent nephrotoxic agent Prophylactic use of H2 receptor agonist or proton pump inhibitor
3) Increased risk of life threatening infections while receiving chemotherapy		Intervene early with broad spectrum antibiotics. Administer IVIG in some cases
4) Ambulation compromised by chemotherapy induced peripheral neuropathy	Limit use of weekly vinca alkaloids. Consider substitution with less neurotoxic vinca alkaloid, vinblastine. Baseline neuroimaging Baseline neurology consultation
5) Increased sensitivity to topoisomerase II inhibitors	Reduce (25%) dosage for these agents (e.g., daunorubicin, etoposide).
6) Poor weight gain while on therapy		Order nutrition consults. Consider total parenteral nutrition with inadequate oral intake. Place central catheter (double lumen). Baseline chewing and swallowing evaluation to determine need for G-tube placement