Alasdair Rankin, Director of Research at Bloodwise, the blood cancer research charity
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The decades of research behind new childhood leukaemia study

Alasdair Rankin, Director of Research at Bloodwise, the blood cancer research charity
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21 May 2018

Today’s news about the causes of the most common form of childhood leukaemia is a story that has been decades in the making

Mel Graves pictured in a laboratory
Professor Mel Greaves

The scientist behind it, Professor Mel Greaves, describes his new paper as the culmination of a 40-year career that has been spent expanding our knowledge of childhood leukaemia.

It was Professor Greaves who first identified that the most common childhood leukaemia, B-cell acute lymphoblastic leukaemia (ALL), could be split into four different types, and this finding has directly led to improved treatments for children with ALL.

He has also identified a genetic mutation in the womb that puts children at greater risk of ALL and has increased our understanding of the role of the immune system. Thanks to his work, we now know that the development of common childhood ALL seems to be a two-stage process where first there is a genetic mutation in the womb and then later, during childhood, there is further genetic damage, most likely triggered by the body reacting in an abnormal way to an infection.

Read more: genetic mutation and infection 'most likely cause' of childhood leukaemia

Professor Greaves thinks that more children are developing common childhood leukaemia in relatively rich nations because the way children are exposed to germs in early life has changed. This is important because our immune systems have to learn to recognise and respond to bacteria and viruses as we grow up, and Professor Greaves thinks that something has changed in the way that happens – and that if we can learn what is needed to educate our immune systems properly in early life then that might be a way to stop leukaemia before it starts.

There are other types of leukaemia that affect children but where leukaemia starts in a different type of cell and a role for infection hasn’t been shown in these cases. Infection does not appear to be important for children who get acute myeloid leukaemia AML, and there is no evidence to date for a role in children who have T-cell ALL.

I should add here that we are certainly not at the point where we can offer a way of reducing risk of ALL. At the moment, a child’s risk of ALL is down to a mixture of genetics and chance and it’s really important that parents of children with ALL don’t get the wrong impression that there might have been something they could have done to prevent it.

But it does raise the incredibly exciting prospect that we may one day be able to stop young children from getting this type of leukaemia by exposing them to some harmless viruses and bacteria that would train their immune systems fight common infections without triggering leukaemia. Finding out whether this is possible would require much more work, starting with experiments to see whether leukaemia can be prevented in mice.

When you put all these discoveries together, it is no surprise that Professor Greaves was last year awarded the Royal Society’s prestigious Royal Medal.

As a former lab researcher myself, I have huge admiration for him and am proud to consider him as a colleague. Yet it would be a mistake to look at today’s story as purely the achievement of one scientist, or even a collection of scientists.

This gets to the heart of what Bloodwise is about. As accomplished a scientist as Professor Greaves is, many of these discoveries in childhood leukaemia have only been possible because of thousands of people with a commitment and determination to make things better for people with blood cancer.

Bloodwise has only been able to fund Professor Greaves’s work over the last 30 years as a result of a movement of people who shake buckets, run marathons, and give money. It is the fantastic efforts and great generosity of all those people, many of them affected by blood cancer themselves, who have given Professor Greaves the platform he has needed to push forward our understanding of leukaemia.

There is, of course, so much more we need to do. While the proportion of children who survive ALL has increased dramatically over the last few decades, there are still too many who die of it or who suffer long-term health issues as a result of their treatment. And looking at blood cancer more broadly, it is the 3rd biggest cause of cancer deaths in the UK.

But as we celebrate the achievements of Professor Greaves and the decades of work that has gone into this new study, I hope those unsung heroes of countless fundraising events take a quiet satisfaction in the fact that this is their achievement, too.

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