As more children with leukemia are cured, prevention and successful treatment of leukemia infiltration in the brain, without toxicity, is a very important goal. How can precision medicine be used to treat leukemic infiltration of brain in pediatric patients? Leading cancer expert. Spread of leukemia to the brain is a major problem. Children with leukemia often already have leukemia cells in the brain at the time of diagnosis. Dr. Anton Titov, MD. Leukemia cells spread to the meningeal coverings and in the brain. You co-authored a paper about treating leukemia in the brain more effectively. Dr. Anton Titov, MD. Because relapses of leukemia often also happen in the brain. Dr. Shai Izraeli, MD. Child leukemia in the brain is a very important problem in treatment of leukemia in children. Before the 1970s children with leukemia were not cured. Then came several effective cancer medications. Leukemia has disappeared from the bone marrow. But leukemia came back in the brain in 75% of the children. Then we realized that you have to do preventive therapy to the brain in every child with leukemia. The way to do preventive cancer therapy was radiotherapy. Dr. Shai Izraeli, MD. Now about 40 - 50% of children were cured from leukemia. But the cost in brain development retardation was enormous. It was an average of 10 points of decrease in IQ after radiotherapy to the brain. Today we almost never irradiate the brain. We sometimes do radiotherapy when leukemia is discovered in the brain. But we give chemotherapy to the brain. We give very high doses of certain cancer medications into the vein. We also inject the spinal canal with cancer medications against leukemia. This also has toxic effects. Now we have some clinical trials 10 - 20 years later. The children cured from leukemia are now normal adults. Dr. Shai Izraeli, MD. I know some professors who were cured from leukemia. But in general they suffer from a decrease in their intellectual capacity. Dr. Anton Titov, MD. Children who survived leukemia and grew up into adulthood also have increase of secondary tumors in the brain. Our huge challenge today is two-fold. One problem is to identify better biomarkers in leukemia. We must know who needs more and who needs less cancer therapy to the brain. Then we also must understand the biology of leukemia better. We have to understand why leukemia cells live the brain. Dr. Anton Titov, MD. Could we treat the brain leukemia more smartly? Dr. Shai Izraeli, MD. That's what we in Schneider hospital do. We treat brain leukemia. We collaborate with other cancer research groups. We work with pediatric oncology specialists in Glasgow, with Dr. Chris Halsey, and in the Technion with Dr. Eyal Gottlieb, in the City of Hope in Los Angeles. We have a whole group that collaborates on the clinical trial of CNS leukemia. We just presented in the American Society of Hematology a discovery of an enzyme. It that has to do with the metabolism of fatty acids in leukemia. Leukemic cells need fatty acids in order to survive the brain. Actually the brain is a very bad place for a blood cell. That's why usually there is no blood cells in the brain. It's like a desert. Brain has no food for cells. We found that leukemia cells have a method to start producing fat in the cells. We hope maybe we can inhibit this cancer enzyme. Then we can specifically cure leukemia in the brain. It's a very big challenge. But that's one of the cancer research areas we focus on in metastatic pediatric leukemia. Environment is also more hypoxic in the brain. Brain is not a good place for cancer cells to live in. There is almost no food, no glucose, no protein, no vitamins, no fatty acids nowhere in the brain.There is no oxygen. But the leukemic cells escape to the brain. Dr. Shai Izraeli, MD. We showed in another publication that one of the reasons leukemia cells grow in the brain is because they can escape from some of the immune cells. We showed that the natural killer immune cells don't enter the brain. But we have to kill cancer cells in the brain. Because today leukemia relapses fortunately are so rare. About 50% of all relapses of leukemia happen in the brain. Dr. Anton Titov, MD. Again, you don't need to be a scientist or leukemia physician to understand that leukemia in the brain is not a good thing.