One of the great success stories in cancer has been the year on year improvement in survival rates for acute lymphoblastic leukaemia (ALL) in children, the commonest form of childhood leukaemia. However, the improvements made for adult ALL have been less spectacular with as a result of biological and genetic differences between the adult and childhood forms of this cancerous disease. But the success story for childhood ALL shines like a bright beacon as a testament to the power of research.
The slow but sure improvements over the years from the early 1960’s where almost no child was cured to today where over 85% survive are illustrated clearly in the graph on this page. The child who survives for five years beyond first treatment is considered cured with only a very small fraction relapsing after this time. This remarkable improvement has been due not only to the introduction of new leukaemia killing drugs but also in learning how to use these in the right combinations at the right time and at the correct dose level. An equally important development has been learning how to manage and support the patient from the often life-threatening side effects of chemotherapy. All this has come about as a result of meticulous clinical trials and other research conducted over six decades that have tried and tested different combinations of drugs given in different ways at different times in the treatment schedule until we have arrived at the happy situation we find today.
Graph showing percentage cure rates for childhood acute lymphoblastic leukaemia from the 1960’s to the 2020’s. Very few survived in the 1960’s now 85% are cured thanks to research.
However, despite this remarkable success it is not all a panacea with around 15% of childhood and 11 – 48% of adult ALL patients, depending on age at diagnosis, whose disease is either resistant to chemotherapy or who relapse shortly after treatment. These patients need something more than just conventional chemotherapy, they need new innovative treatments that are safe and effective and work for them.Then there is the toxicity of chemotherapy that makes treatment hazardous and even life threatening for all patients. In the case of young children chemotherapy can also cause lasting effects such as growth and hormonal problems that extend into adulthood and can cause long term health problems.
So, as successful as chemotherapy has been in childhood ALL it has its downside and there is a compelling argument that treatment needs to be made as safe and as minimally toxic as possible. This has been partially achieved by identifying patients whose disease characteristics require less chemotherapy to effect a cure but this is only a stopgap solution and what is really needed, not just for leukaemia but for all cancers are new innovative forms of treatment that will cure even more effectively with the minimum of side effects.This has been the dream of oncologists for more than a century and is now coming to fruition with the recent developments and successes that immunotherapy is delivering for leukaemia, lymphoma and many other cancers besides.
Immunotherapy offers the chance to selectively attack cancer cells without the usual damage that is done by conventional chemotherapy. You can read about the revolution immunotherapy is bringing to leukaemia and cancer treatment in general by clicking here.
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