Story #38 of 50 days, 50 Stories Campaign
Childhood cancers are uncommon but no longer rare in today’s world. Each year, approximately 15,700 children are diagnosed with cancer. In the US, it is also the 2nd most common cause of death second only to accidents. It is always very anguishing to break the news to a parent that their child has cancer. Childhood cancers, however, differ a lot from adult cancers. Adult cancers are mainly identified by their site of origin eg., breast cancer, lung cancer, etc. But childhood cancers are classified by the cell that they originate from so a hepatoblastoma or neuroblastoma etc.
The commonest cancer that we see in the pediatric age group is blood cancer or ALL. Figure 1 talks about age-adjusted and age-specific (0–14 years) Surveillance, Epidemiology, and End Results cancer incidence rates from 2009 to 2012. This is by the International Classification of Childhood Cancer group and subgroup and takes into account the age at diagnosis, including myelodysplastic syndrome and group III benign brain/central nervous system tumors for all races, males, and females.
While the adult oncologists talk about progression-free survival; the pediatric oncologist talks about overall survival and cure from cancer. A lot of advances have been made and the treatment has advanced from “Tender loving care till death” to directed therapy over the last 60-70 years. This has pushed overall survival to 84% for all types of cancers and even >90% for a lot of specific cancers.
This was the global scenario; however, the situation in India is very different. Reporting for pediatric cancers is done mainly by population-based cancer registries (PBCR) across the country. It is estimated that the cancer incidence is 235.3 per million for boys and 152.3 per million for girls in Delhi. This may be different for different states. The risk factors for developing cancer for children are not lifestyle exposures as is the case with adults. In children, we do not know what causes cancer – however, we believe that the triggering factors may be ionizing radiation, exposure to pollution, exposure to pesticides, infections acting as triggers, and in some cases genetic factors may also have a role.
Acute lymphoblastic leukemia ( ALL), is the commonest malignancy seen in the pediatric population. For standard-risk disease, the cure rates are between 80-85% in most centers, while the cure rates for high-risk disease would be between 50-60%. Some of these children will eventually relapse and would need more aggressive
treatment and in some cases may need a blood stem cell transplant as well. The field of blood stem cell transplantation is a very dynamic field at present and a lot of research is going on. We have moved from bone marrow donations to peripheral blood stem cell collections and are also talking about cell selection prior to infusion. Blood stem cell transplants offer a ray of hope for those children who have relapsed.
Blood Stem cell transplantation is not only used to treat relapsed cancers but also for high-risk cancers controlled by chemotherapy. It is also used for a number of non-cancerous conditions in children where the marrow is not functioning properly.
The best results are seen with matched sibling donor transplants; however, only about 30% of the children have an HLA-matched sibling. Other patients have to rely on unrelated matched blood stem cell donors. For diseases like blood cancer, thalassemia, SCID, and other such severe blood-related disorders a blood stem cell transplant is the last ray of hope. Any healthy individual within the age group of 18-50 years can become a blood stem cell donor. The donation process is fairly simple and has the power to save lives. Even though India has the largest population in the world, our donor registries are very young and only a negligible population are registered as blood stem cell donors.
The need of the hour is to increase awareness about the curability of childhood blood cancers and that is why we need to have more volunteer registered donors from all walks of life as a heterogeneous and diverse registry will help in saving more lives.
DATRI is a Not-for-Profit organization founded in 2009 with a mission to save lives of those suffering from life-threatening Fatal blood disorders like Blood Cancer, Thalassemia, Leukemia, Aplastic Anemia, Sickle Cell Anaemia, etc.
DATRI is registered with the Government of India as a Section 8 organization, and all monetary contributions towards DATRI are subject to 80G exemptions