Beating childhood leukaemia
We’ve changed the world for children with blood cancer. But we won’t stop until every child survives and can go on to live their life, free from the harsh side effects of treatment and fear of relapse.
Acute lymphoblastic leukaemia (ALL) is the most common childhood cancer. One child a day is diagnosed with ALL in the UK – that’s one family turned upside down every 24 hours.
Of all the work we’ve done for blood cancer patients since 1960, it’s in childhood ALL where we’ve made the biggest impact. In fact, it's where it all started for us: the Eastwood family founded our charity in that year after their daughter Susan sadly died from childhood leukaemia. Back then, the survival rate for children with ALL was less than 1 in 10 – we’ve helped increase it to 9 in 10.
The improvements in survival rates and quality of life we’ve seen so far are down to a global commitment to research, led in no small part by the UK.
Our impact so far
It was in childhood ALL, in the late 1950s and 60s, that researchers first had an inkling that we could use combinations of drugs to treat cancer, rather than radiotherapy or surgery – or in the case of childhood ALL, doing nothing.
These chemotherapy drugs meant we were able to achieve short, temporary remission in children: it allowed us to see what could be possible.
In the 1970s we realised that children were more resilient that we thought, and we could treat them more intensively with these drugs. This meant that more survived: 4 in 10, up from only 1 in 10 back in 1960. By the 1990s it had risen even further, to 8 in 10.
These intensive treatments allowed us to increase survival rates dramatically. But treating everyone the same way with 2–3 years of toxic chemotherapy meant that some children were having more treatment than they needed, leading to physical and emotional side effects, complications in later life and – in some cases – children dying because of their treatment, rather than their disease.
So we needed to know which children we could treat less intensively and which we couldn’t. Our researchers have made – and continue to make – crucial discoveries that have helped to answer this very question.
Personalised cancer medicine
In the 1990s we started to understand the biology of the disease better, through technologies that allowed scientists to see chromosomes better than ever before and DNA sequencing methods. So we were able to identify some genetic abnormalities associated with ALL, so we could begin to predict what level of risk each child had. We can now classify children with ALL into low, intermediate and higher risk groups according to the genetic faults associated with the cancer. Children then get one of three treatment regimens and the lowest risk patients can safely be treated less intensively, so reducing their side effects.
Because of our visionary support for research into childhood leukaemia, the classification and treatment of children according to their risk is now embedded in the NHS. It’s influenced the treatment of patients worldwide.
The Minimal Residual Disease test
The MRD test looks at how children respond to their initial treatment, and can also be used to check if children are relapsing. Thanks to our researchers, it was possible to use the test in a national clinical trial (UKALL 2003). The trial proved that we can ease off treatment if a child’s disease drops below a certain level after they are initially treated, limiting damaging side effects but not affecting their chance of a cure. We also know which children we need to treat more intensively.
Because of us, the MRD test has been adopted as standard of care in the NHS for children with ALL.
The UKALL 2011 trial
We’re now funding a follow-on study called UKALL 2011, which almost every child with ALL in the country enters. The trial is looking at how we can decrease drug doses to reduce side effects and the risk of relapse even further, and is also gathering insights from parents about the impact that a diagnosis has on quality of life.
We’re learning from each and every child involved in the trial.
Preventing childhood leukaemia
Thanks to our researchers, we already know that the origin of leukaemia is in the womb. By studying twins, where leukaemia has developed at different times in each child, we’ve found out about pre-leukaemia cells and how important they are. We know these cells are present at birth in far more children than the number who go on to develop leukaemia – so we understand that a second ‘event’ is needed to trigger the development of the disease.
Now we know that, our researchers can work out what it is and how to stop it.