Acute lymphoblastic leukemia is the most commonly diagnosed type of cancer in children. Estimates indicate that in Spain About 1,296 cases of the disease are detected each year, according to the Spanish Registry of Childhood Tumors. It is also the one with the highest survival rate: according to the CONCORD-3 study, the 5-year survival rate after diagnosis is 84.7%. However, although these are good figures, it occupies 13th place in the European ranking and other countries on the continent surpass them. The top five are Finland, Denmark, Iceland, the United Kingdom and Germany, with figures ranging from 95.2% to 91.1%.
Luis Madero, head of the oncology department at the Niño Jesús Hospital in Madrid, recalls that in Spain the number of diagnoses of acute lymphoblastic leukemia in children each year accounts for nearly 78% of all pediatric tumors. “A fairly considerable amount,” he emphasizes. He also explains that there is a great diversity of centers where it can be treated. Something that, depending on how you look at it, may not be entirely positive.
Although it is a controversial issue, it would be more efficient to have a few centres, but they should be highly specialised, he says. “When all patients are treated at one site or at a very small number, results generally improve“It is difficult to do in our country, precisely because there are a very large number of hospitals that treat children with leukemia and “this makes the results less uniform,” he explains.
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On the other hand, the countries mentioned above have lower incidences, although that is not the only difference. They also work in a different way: “in a very orderly way,” he describes. Madero says they have been treating their patients for more than two decades “in the same way, in the same centers and in very few hospitals”.
The oncologist emphasizes that Comparing these types of values is always complicated.. It must be taken into account, among other details, that they do not have the same number of patients, protocols or centers in which the disease is treated, he adds. He also points out that with more updated figures, “Spain would probably be in a better position.” However, he acknowledges: “They are certainly not bad [los datos españoles]even though they can and will be improved.
An international project
This improvement also involves betting on precision medicineboth in treatments and in diagnostic tests. In fact, these five territories with the best data have something in common: they belong to the international ALL Together project. This is a European consortium in which 14 countries already participate. It began in 2018 and is based on the use of a single protocol to treat patients.
ALL Together also stands out for its advances in diagnostics thanks to tests that allow us to understand the tumor at the molecular level. In this way, Treatment can be personalized for each child and adjust its intensity based on the risk posed by the disease, Madero describes. “Years ago, it couldn’t be quantified because there wasn’t that precision.”
This is the first time that the country is part of an international project like this to treat this disease, says the specialist. In addition, it opens itself up to sharing information with other countries and Their cases are added to the 6,000 EuropeansThis will provide information that can improve research and accelerate progress in healing, says Elena Huarte-Mendicoa, director of the Unoentrecienmil Foundation.
Spain began to be part of the project in 2021 with the Niño Jesús Hospital in Madrid and the Sant Joan de Déu Hospital in Barcelona. As progress is made, other centers will be incorporated until they include “those with the most experience, resources and knowledge” have. Soon, the Vall’de Hebron (also in the Catalan capital) and the Hospital de La Fe (Valencia) will be incorporated. Even if these and other centers are added, this diagnostic typing will continue to be carried out in the two pioneer centers, which will continue to act as central laboratories, says Madero.
The fight with public health
The Unoentrecienmil Foundation works to promote the cure of childhood leukemia and has financed the beginnings of the All Together project in Spain. They finance the first pilot test to include the first 100 children treated with this protocol. Today, they are fighting so that once this hundred is reached, the National Health System will cover the costs of this project.
Its director defends that it is “absolutely necessary” interterritorial coordination within the country. “It is not an exclusive problem of the Government or the Ministry, all the autonomous communities must work in coordination.” This is the only way to carry out all these more precise diagnostic tests in the two designated centers, as Madero commented. For this, adds Huarte-Mendicoa, “a lot of work is needed between the different communities.”
