Every year 300 families in Spain receive the blow of knowing that they have a child with acute lymphoblastic leukemia, the most common childhood leukemia. The hard blow is followed by the news that at least 80% are cured. “But instinctively your mind is left with that 20% does not exceed it and that your little one is going to be there,” says María Hernández and her mind goes back to eleven thirty at night on July 23, 2019, the moment in which they were informed of Nacho’s diagnosis and in which she thought that behind the cold figures, twenty children out of a hundred, “with names and surnames”, did not succeed.
With the aim of achieving full healing and that no one is left on the road, scientists from 14 European countries have launched the All Together project, to which Spain joins through the Niño Jesús Hospital in Madrid and the Sant Joan de Déu of Barcelona. This clinical trial, led by the Spanish Society of Pediatric Hematology and Oncology (SEHOP), aims for patients to receive a personalized treatment that from the first moment fight your tumor with the greatest possible precision. “We can, for example, implement immunotherapy in earlier stages or that children receive chemo adapted to their disease”, explains Susana Rives, hematologist at Sant Joan de Déu.
Research for the cure of this type of cancer has reached a ceiling difficult to overcome in our country without international support. The data has stagnated because the available sample is relatively small. Hence the importance of this project, which will allow access to a larger sample and make larger subgroups, which will provide more precise information.
“Immunotherapy helps children’s bodies not change so much and stop feeling special”
The trial also seeks another objective: to reduce the impact that the tumor and its treatment have on the lives of families. “It’s great that cure expectations are 80%, but it’s also about reduce side effects and avoid such suffering“, points out Elena Huarte-Mendicoa, CEO of Unoentrecienmil. This foundation, created in 2012 with the aim of promoting childhood leukemia research projects, has contributed 590,000 euros to All Together.
The amount will be allocated to the accreditation of the laboratories of the aforementioned hospitals so that they can meet the quality standards set to form part of the project. After the two-year duration of this stage, it is expected that In 2023, more than 40 hospitals in Spain with a Pediatric Oncology / Hematology unit will be able to participate in it and so that all minors diagnosed with acute lymphoblastic leukemia have access to the therapies studied as close as possible to their home.
Nacho was prescribed immunotherapy in a fairly initial phase of the process and that, although it has not prevented the bone marrow transplant, is making it possible for him to recover his life sooner with less medication. “I even look like a normal child”He told his mother a few days ago when, after several months, swollen by the corticosteroids, he was able to put on a pair of jeans. “You are normal, what happens is that you have been ill,” she replied, shaving her head when his hair fell out from chemotherapy so that he would not go through that trauma alone.
“Immunotherapy helps that, so that children’s bodies do not change so much and they stop feeling special,” says María and looks closer to the day when diagnoses of childhood leukemia are followed by the news that they are fully curable : “It’s what a parent needs to hear”.
“We are looking to heal more and heal better”
Susana Rives is a hematologist at the Sant Joan de Déu Hospital and coordinator of the Leukemia Group of the Spanish Society of Pediatric Hematology and Oncology (SEHOP)
What is immunotherapy? There are many cancers that we do not get thanks to the immune system. But sometimes cancer cells become resistant and escape surveillance. We have progressively found drugs that using T lymphocytes can destroy these cells. Through different mechanisms, we get the immune system to recognize them again.
How is it necessary to adapt the laboratories that participate in All Together? We must standardize and meet minimum criteria so that the results we give are identical wherever they are done. We have to do more tests than we do now and in less time because it is a highly personalized medicine and based on genetic alterations we will treat the disease in one way or another. Laboratories must be accredited, technicians trained and a network established.
Will the trial be for new diagnoses? Yes. New drugs are used first when what you already have doesn’t work. Once it has been shown that, although not always, immunotherapy works in resistant cases, the idea is to use it beforehand to see if we can cure patients that we could not cure or prevent them from relapsing and, on the other hand, reduce the intensity of the treatments. It is not about replacing chemo entirely but rather combining it to heal more and better, with less.
Can it be extrapolated to other tumors? With some other type of leukemias, it has already been seen that lowering the intensity but applying precision treatments can work. But as a generic thing. Each treatment must be studied with a specific disease and population.