Clinical Focus

  • Hematology/Oncology
  • Sarcoma, Soft Tissue
  • Pediatrics

Academic Appointments

Administrative Appointments

  • Associate Chair - Clinical, Department of Pediatrics, Stanford University School of Medicine (2013 - Present)
  • Division Chief, Pediatric Hematology/Oncology, Stanford University School of Medicine (2014 - Present)

Professional Education

  • Medical Education:University of Michigan (1992) MI
  • Residency:UCLA (1994) CA
  • Board Certification: Pediatrics, American Board of Pediatrics (1995)
  • Fellowship:Johns Hopkins School of Medicine (1998) MD
  • Board Certification: Hematology/Oncology, American Board of Pediatrics (1998)

Research & Scholarship

Current Research and Scholarly Interests

My research focuses primarily on the management of children, adolescents, and young adults with soft tissue sarcomas. I also have an interest in developmental therapeutics and late effects of cancer therapy,

Clinical Trials

  • Observation, Radiation Therapy, Combination Chemotherapy, and/or Surgery in Treating Young Patients With Soft Tissue Sarcoma Not Recruiting

    This phase III trial is studying observation to see how well a risk based treatment strategy works in patients with soft tissue sarcoma. In the study, patients are assigned to receive surgery +/- radiotherapy +/- chemotherapy depending on their risk of recurrence. Sometimes, after surgery, the tumor may not need additional treatment until it progresses. In this case, observation may be sufficient. Radiation therapy uses high-energy x-rays to kill tumor cells. Drugs used in chemotherapy, such as ifosfamide and doxorubicin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving chemotherapy and radiation therapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed. Giving these treatments after surgery may kill any tumor cells that remain after surgery.

    Stanford is currently not accepting patients for this trial. For more information, please contact Nadeem Mukhtar, (650) 725 - 1662.

    View full details


Journal Articles

  • Growth Plate Abnormalities in Pediatric Cancer Patients Undergoing Phase 1 Anti-Angiogenic Therapy: A Report From the Children's Oncology Group Phase I Consortium PEDIATRIC BLOOD & CANCER Voss, S. D., Glade-Bender, J., Spunt, S. L., DuBois, S. G., Widemann, B. C., Park, J. R., Leary, S. E., Nelson, M. D., Adamson, P. C., Blaney, S. M., Weigel, B. 2015; 62 (1): 45-51

    View details for DOI 10.1002/pbc.25229

    View details for Web of Science ID 000345319300010

  • Imaging Features of Alveolar SoftPart Sarcoma: A Report From Children's Oncology Group Study ARST0332 AMERICAN JOURNAL OF ROENTGENOLOGY McCarville, M. B., Muzzafar, S., Kao, S. C., Coffin, C. M., Parham, D. M., Anderson, J. R., Spunt, S. L. 2014; 203 (6): 1345-1352


    There are few studies in the literature regarding the imaging features of alveolar soft-part sarcoma (ASPS). We performed a comprehensive assessment of the imaging characteristics of this rare tumor to determine whether there are features that suggest the diagnosis.Twenty-two subjects with ASPS underwent pretherapy imaging as part of enrollment in Children's Oncology Group protocol ARST0332 for the treatment of nonrhabdomyosarcoma soft-tissue sarcomas: 16 patients underwent MRI; three, CT; and three, both MRI and CT. Two radiologists retrospectively reviewed the imaging studies by consensus and recorded tumor location, size, contour, internal architecture, signal characteristics, presence of flow voids, and enhancement patterns.The 12 females and 10 males in the study group ranged in age from 8 to 23 years 7 months (mean, 15 years 8 months). The most common anatomic site was the lower extremity (12/22, 55%) followed by the upper extremity (4/22, 18%). The maximal tumor diameter ranged from 2.3 to 20.0 cm (median, 5.9 cm). All tumors imaged with MRI had flow voids (19/19, 100%), and 19 (19/22, 86%) had large peripheral vessels, lobulated margins, and nodular internal architecture. Unenhanced T1-weighted MRI was available for 18 tumors: 14 (14/18, 78%) appeared slightly hyperintense to muscle. Of the 16 tumors imaged with contrast material, 11 (11/16, 69%) showed intense enhancement and five (5/16, 31%), moderate enhancement. Six tumors (6/16, 38%) had a thick enhancing peripheral rim with a nonenhancing center consistent with necrosis.The imaging features of ASPS include flow voids, large peripheral vessels, internal nodularity, and lobulated margins. Contrast administration produces intense to moderate enhancement, sometimes with a thick enhancing peripheral rim around central necrosis. Extremity tumors with these imaging features in a child or young adult should suggest the diagnosis of ASPS.

    View details for DOI 10.2214/AJR.14.12462

    View details for Web of Science ID 000347527500050

    View details for PubMedID 25415714

  • Cumulative alkylating agent exposure and semen parameters in adult survivors of childhood cancer: a report from the St Jude Lifetime Cohort Study LANCET ONCOLOGY Green, D. M., Liu, W., Kutteh, W. H., Ke, R. W., Shelton, K. C., Sklar, C. A., Chemaitilly, W., Pui, C., Klosky, J. L., Spunt, S. L., Metzger, M. L., Srivastava, D., Ness, K. K., Robison, L. L., Hudson, M. M. 2014; 15 (11): 1215-1223
  • Cyclophosphamide dose intensification during induction therapy for intermediate-risk pediatric rhabdomyosarcoma is feasible but does not improve outcome: A report from the soft tissue sarcoma committee of the children's oncology group CLINICAL CANCER RESEARCH Spunt, S. L., Smith, L. M., Ruymann, F. B., Qualman, S. J., Donaldson, S. S., Rodeberg, D. A., Anderson, J. R., Crist, W. M., Link, M. P. 2004; 10 (18): 6072-6079


    More than half of pediatric rhabdomyosarcoma cases have intermediate-risk features and suboptimal outcome (3-year failure-free survival estimates, 55 to 76%). Dose intensification of known active agents may improve outcome.This pilot study evaluated the feasibility of dose intensification of cyclophosphamide in previously untreated patients ages < 21 years with intermediate-risk rhabdomyosarcoma. Induction therapy comprised four 3-week cycles of VAC: vincristine (V) 1.5 mg/m2 on days 0, 7, and 14; actinomycin D (A) 1.35 mg/m2 on day 0; and dose-intensified cyclophosphamide (C) on days 0, 1, and 2. The three cyclophosphamide dose levels tested were as follows: (a) 1.2 g/m2/dose; (b) 1.5 g/m2/dose; and (c) 1.8 g/m2/dose. Continuation therapy comprised nine additional cycles of VAC with 2.2 g/m2/cycle of C. Radiotherapy was administered at week 0 (parameningeal tumors with intracranial extension) or week 12 or 15 (all others).Between October 1996 and August 1999, 115 eligible patients were enrolled. Three of 15 patients treated at dose level 2 experienced life-threatening dose-limiting toxicity (typhlitis +/- other severe toxicity). Dose level 1 was the maximum-tolerated dose, and 91 evaluable patients were treated at this level. The 3-year failure-free and overall survival estimates for patients treated at the maximum-tolerated dose were 52% (95% confidence interval, 41-64%) and 67% (95% confidence interval, 56-77%), respectively, at a median follow-up of 3 years.A 64% increase in the standard cyclophosphamide dosage during induction (to 3.6 g/m2/cycle) was tolerated. However, outcomes were similar to those observed at lower dosages, suggesting that alkylator dose intensification does not benefit patients with intermediate-risk rhabdomyosarcoma.

    View details for Web of Science ID 000224080200014

    View details for PubMedID 15447992

  • Late events occurring five years or more after successful therapy for childhood rhabdomyosarcoma: a report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group EUROPEAN JOURNAL OF CANCER Sung, L., Anderson, J. R., Donaldson, S. S., Spunt, S. L., Crist, W. M., Pappo, A. S. 2004; 40 (12): 1878-1885


    The aim of our study was to describe late failures in children who initially survived event-free five years from a diagnosis of rhabdomyosarcoma. Charts of children enrolled in the Intergroup Rhabdomyosarcoma Study Group (IRSG) trials III, IV pilot and IV (1984-1997) who survived five years event-free and subsequently experienced an adverse event (disease recurrence, second malignant neoplasm or death from other causes) were reviewed. Of the 2534 enrolled patients, 1160 were event-free at five years and 48 subsequently experienced a late event. The estimated 10-year event rate for the 1160 patients who were alive and event-free at five years was 9% (95% Confidence Interval (CI) 5%, 13%). Patients with both advanced disease (Group III/IV) and large primary tumours at diagnosis (> 5 cm) were at the highest risk for late events (19%; 95% CI 8%, 30%). Late events after successful treatment for rhabdomyosarcoma occur in 9%. Those with advanced disease and large primary tumours have the highest risk of late events.

    View details for DOI 10.1016/j.ejca.2004.04.005

    View details for Web of Science ID 000223456600018

    View details for PubMedID 15288290

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