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What is new in child leukemia treatment? Precision medicine! 1
Precision medicine era arrived in pediatric leukemia treatment. It means we hope to cure every child from leukemia, and do so with fewer side effects. Leading child cancer expert. You study childhood leukemia. It’s a very complicated disease. Dr. Anton Titov, MD. What is new in pediatric leukemia diagnosis and treatment? Where has the progress been made over the last 40 years? Dr. Shai Izraeli, MD. When I was a child, very very few children were cured from leukemia. This is in the 1960s. Now, 40 years or so later, we cure most of children with leukemia. Almost 90% of children with leukemia are cured today. The most common type of leukemia is acute lymphoblastic leukemia. that’s unbelievable. This was achieved because of three processes. First, from the beginning, children have been treated according to international chemotherapy cancer treatment protocols. For example, in the case of the United States, national cancer treatment protocols, multicenter cancer treatment protocols of pediatric cancer treatment. changes were made to the cancer treatment protocols every couple of years. You can learn from previous experience and apply it to the next. Dr. Shai Izraeli, MD. Then the second pillar on this the progress of treatment of leukemia occurred. These pediatricians who were the pioneers, they were geneticists. we learned that not all leukemias are the same. you may have two children whose leukemias look the same in the microscopes and blood counts, etc. Dr. Anton Titov, MD. But they are very different leukemias by genetics. Now we adapt leukemia therapy to the genetic subtype of leukemia. Dr. Shai Izraeli, MD. The third pillar of leukemia therapy progress that has been critically important. It is the progress in child cancer treatment in general. But it is important especially in leukemia. It is the development of supportive care. you cannot just treat leukemia without support system. We have here in Schneider Children’s Medical Center great supportive treatment capabilities. I sometimes joke that the whole hospital is working for me. It is intensive care unit, infectious disease unit, pharmacology unit, etc. you need the supportive care. We are now in this stage. We can cure the majority of children with leukemia. Dr. Shai Izraeli, MD. We are in the beginning of new era in leukemia treatment. But it is also a new era in general for child cancer treatment. In this new era we can really hope, without exaggeration, to cure every child with leukemia over the next 20 – 30 years. The second very big challenge is to lower toxicity of therapy. We need to lower toxicity of therapy because now our leukemia treatment is incredibly toxic. We treat leukemia with 10 to 12 different cancer medications or types of chemotherapy, usually over two years. Quite often our kids with leukemia go to intensive care units. We have long term toxicities. For example, up to 20 to 40% of adolescents that are being cured from leukemia have afterwards fractures. They have other problems in their bones due to steroids used in leukemia treatment. At least 20% or more of the deaths occur because of leukemia treatment. Dr. Shai Izraeli, MD. There is a treatment-related mortality, treatment-related death in child leukemia. We have a problem of delayed side-effects. We have to remember that child leukemia therapy is very different from adult medicine. If I am now diagnosed with cancer, a reasonable goal would be to keep me around for 10 – 20 years. I tell this to the parents who come to our department. Our goal is that their children will have grandchildren. It’s a completely different dimension. we have to think about delayed cancer treatment side effects. Dr. Shai Izraeli, MD. Delayed leukemia treatment side effects are related to treatment of the brain, for example. We have been talking about it. Dr. Anton Titov, MD. Delayed cancer therapy side effects are secondary cancers. There is increased rate of secondary cancer. now our goal is to cure every child with leukemia. We have to do that with less toxic therapy. Dr. Anton Titov, MD. It is now the time to invest a lot in biology and research to achieve cure for children with leukemia.
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