Leukemia is the most common malignancy seen in childhood, accounting for 1 in 3 cancer diagnoses among children and teens. Fortunately, treatment advances have led to improved outcomes, due, in part, to the stratification of patients and the provision of individualized therapy.
“Before, we were treating all leukemias the same way,” says Guillermo De Angulo, MD, board-certified pediatric hematologist/oncologist who provides care within the Nicklaus Children’s Hospital Cancer and Blood Disorders Institute. “We can now identify targetable mutations and identify whether a child will respond to chemotherapy or require a different approach.”
Blending Standard and Novel Approaches
At Nicklaus Children’s, every form of leukemia therapy is available, including:
- Apheresis therapy
- Blood and marrow transplantation
- Chemotherapy
- Immunotherapy and other targeted therapies
- T-cell collection by apheresis
Chemotherapy has long been the standard treatment for children with leukemia, but cancer researchers, including those with the Cancer and Blood Disorders Institute, have been actively researching which targeted therapies, such as immunotherapies and T-cell therapies, work best for children based on their diagnosis.
“The question now is whether we can remove conventional chemotherapy from the treatment regimen in new diagnoses and start treatment with immunotherapy,” Dr. De Angulo says. “We may have that answer eventually, but it will take a while. It’s tough to make changes when chemotherapy has a survivorship of 90 percent or higher.”
However, advances in treatments now allow clinicians to change course midstream and opt for the most appropriate path based on a child’s physiology and response to treatment.
“Nowadays, we can identify if a child responds to conventional chemotherapy,” Dr. De Angulo says. “But we can find an alternative treatment, whether immunotherapy or targeted therapy, if we notice conventional methods are not adequate enough.”
Immunotherapies may also offer an alternative for children with relapsed leukemia. At the Cancer and Blood Disorders Institute, clinicians often prescribe newer therapies or enroll them in clinical trials, if possible, to improve their prognosis.
“We’re always willing to think outside the box, if needed,” Dr. De Angulo says.
A Fully Cooperative Effort
Proper leukemia care not only considers the treatments necessary to eradicate disease — it attends to the well-being of the whole person. To address all a child’s physical and emotional needs, each patient and family has a multidisciplinary care team that includes:
- Hematologist/oncologists
- Nurse navigators
- Nurse practitioners
- Nutritionists
- Pediatric psychologists
The team works closely with families to ensure they understand their child’s diagnosis, which treatments their child will receive and why.
“It’s difficult when families are not properly educated on their child’s care,” Dr. De Angulo says. “Our clinical educators review each situation to help them understand the entire process.”
The multidisciplinary care continues after treatment. When a patient’s therapeutic regimen ends, they have monthly follow-up visits that continue for as long as the oncology team deems necessary, and then the patient transitions to the Survive & Thrive Cancer Survivorship Program.
The program addresses treatment side effects with medical care encompassing cardiology, endocrinology, neuropsychology and behavioral medicine. Social workers and school coordinators also help patients and families reintegrate back into daily life.
“This follow-up care is time-consuming but very necessary in this population,” Dr. De Angulo says.
Support for the Entire Family
“The C word I tend to use most often is curable,” Dr. De Angulo says. “Our goal is cure. While working toward that, we don’t want leukemia treatment to rob children of their childhood.”
Throughout treatment, children are encouraged to maintain as much normalcy in their lives as possible, including attending school. The team at Nicklaus Children’s finds that such an approach leads to better results. The Cancer and Blood Disorders Institute also offers ambulatory cancer treatment in its outpatient infusion unit, making it easier for children to maintain their routines.
However, the impact of care extends beyond the child’s life. Leukemia treatment can take up to two years to complete, and families often move to our area for treatment, not only putting caregivers’ lives on hold but also those of the patients’ siblings.
“When a child has leukemia, their siblings go through a lot,” Dr. De Angulo says. “They may have to attend a new school and learn a new language, all while their sibling is sick and their parents are spending time at the hospital.”
To help ease these transitions, Nicklaus Children’s offers group family therapy and special events for siblings. Their survivorship program’s social workers and school liaisons can assist with families’ needs as well as those of patients.
An International Leader in Individualized Care
The Cancer and Blood Disorders Institute treats patients from across the U.S. and Latin America. Regardless of patients’ home country, the institute’s hematology/oncology specialists remain committed to offering the most fitting treatment for each patient.
“We provide white-glove service every day,” Dr. De Angulo says. “Combining top-notch care with 24/7 access leads to excellent long-term outcomes.”
To learn more about leukemia care at the Cancer and Blood Disorders Institute, email our physician liaison.
