Where are we and where are we heading in paediatric oncology and haematology
The scientific vista of the current state of paediatric oncology and haematology, which emerged from lectures and discussions of participants in the 11th Congress of the Polish Society of Paediatric Oncology and Haematology (Polskiego Towarzystwa Onkologii i Hematologii Dziecięcej – PTOHD), according to Prof. Jan Styczyński, President of the Scientific Committee to 11th PTOHD Congress, symbolises the continuity of cooperation strongly manifested by the whole scientific environment. It makes one realise that all 18 paediatric oncology and haematology centres have been continuously growing, using unified therapeutic programmes, treating patients according to the same state-of-the-art rules and sharing knowledge.
Prof. Styczyński told us: “This most important scientific and educational event of the year was organised under slogans of ‘ultimate’ and ‘state-of-the-art’ which emphasise scientific advances in our discipline. We’ve joined the AIEOP-BFM Group which focuses on treating severe forms of lymphoblastic leukaemia and, as a consequence, a Polish version of the group’s programme was created. We’ve gained access to the revolutionary CAR-T cell therapy and to blinatumomab and dinutuximab beta – thanks to the group’s financial support. We’ve been using molecular diagnostics when selecting the most suitable forms of targeted therapy. The next challenge awaiting us in the future is the introduction of full molecular diagnostics in all cancerous illnesses in children,” – in these words Prof. Styczyński explained the choice of leading topics of the 11th Congress, illustrating the present status quo and heralding the future (quo vadis?) of paediatric oncology and haematology.
During the 11th PTOHD Congress, a wide panel of experts presented scientific and practical aspects of diagnosing and treating blood and cancerous diseases. Topics focused mainly on interdisciplinary approach in paediatric oncology and haematology – i.e. on cooperation not only with surgeons and radiotherapists, as it is traditionally understood, but also with e.g. immunologists, geneticists or radiologists, and also focused on aforementioned molecular research in oncological diagnostics.
Sessions were dedicated to neoplastic diseases, such as: acute lymphoblastic leukaemia, myeloproliferation, myelodysplasia, CNS tumours, phacomatosis, solid tumours (multidisciplinary approach to difficult cases), lymphomas, non-cancerous blood diseases, distortions of haemostasis, rare diseases, and complications in oncological therapies. At interdisciplinary sessions, oncological-surgical topics and overlapping topics from haematology and clinical immunology were discussed.
“Each session was definitely worth participating in,” – summed up Prof. Styczyński. As an undisputed “hightlight” should be treated two interdisciplinary haematologic/immunologic sessions which discussed the issues of immunology deficiencies and various forms of cytopenia: neutropenia, thrombocytopenia, and anaemia. The second exceptional session discussed new diseases – those that did not appear or perhaps were not discovered in the past. The topic of genetic and molecular testing in modern diagnostics and treatment was present in all sessions.
One of the speakers of the Congress was Prof. Carmelo Rizzari, President of the European Society for Paediatric Oncology (SIOPE), Head of the Paediatric Haematology-Oncology Unit at the Department of Paediatrics of the University of Milano-Bicocca. As a researcher he specialises in children’s leukaemia and chemotherapy of cancers. He has participated in the development of a number of chemotherapy protocols for childhood acute lymphoblastic leukaemia (ALL) and acute myeloid leukemia (AML). He is currently Chair of the ALL Scientific Committee within the Italian Association of Pediatric Hematology and Oncology (AIEOP) and a member of the steering committee of the ongoing international protocol, AIEOP-BFM ALL 2017, for first-line treatment of childhood ALL. He is also international co-Chair of the AIEOP-BFM ALL working group on asparaginase studies and co-Chair of the Clinical Trials Council for the European Society of Paediatric Oncology (SIOPE).
“In his presentation, Prof. Rizzari spoke about one of the key drugs used in treating acute lymphoblastic leukaemia and non-Hodgkin lymphoma in children – asparaginase – and also about the academic clinical study AIEOP-BFM ALL 2009. The most recent form of asparaginase is its variant characterised by prolonged effects: PEG-asparaginase. Using this agent is associated with a risk of adverse side effects, such as: silent inactivation, pancreatitis and thrombotic complications. The AIEOP-BFM-2009 study confirmed efficacy of the agent, retaining an acceptable level of its toxicity. Proper application of the drug requires marking its activity in serum (which has been performed in Poland for many years). It was pointed out in the AIEOP-BFM-2009 study that using PEG-asparaginase ensures therapeutic efficacy practically in all patients, which previously was not always achievable when using the native form of the drug,” – as Prof. Styczyński explained.
“For the first time at the PTOHD Congress, we have introduced the Presidential Symposium which presented papers that received the best reviews. The main topics of the Presidential Symposium were: COVID-19, diagnostics of neutropenia, treating thyroid cancer, treating one form of leukaemia with ruxolitinib, late complications of oncological therapies and possibility of retaining fertility in girls who underwent a transplant of haematopoietic stem cells,” – Prof. Styczyński praised the new initiative. During the Symposium, the audience was full, which confirms how big is the interest in these topics.
According to Prof. Styczyński, the scope of scientific topics, research and discoveries, that was presented in Bydgoszcz, adequately reflects advances in paediatric oncology and haematology and, at the same time, draws attention to the challenges and requirements of the Polish clinical centres specialising in these fields: “We have achieved a level of curability in paediatric oncology and haematology reaching over 80% of patients. In its rapid development clinical medicine has been using more and more advanced methods taken from other scientific disciplines. Further improvements in curability – both in oncology and haematology – will depend on precise molecular diagnostics and more frequent chance to employ targeted therapies that are molecularly oriented, which in turn requires increased financing of diagnostics and therapies. Such governmental decisions are awaited by both doctors and patients.”
The President of the Scientific Committee to 11th PTOHD Congress believes that congresses of every scientific society are the most important events for its members, while participation in particular sessions and an opportunity for a direct exchange of experience and views should be considered priceless.
“Between 2nd and 4th June, Bydgoszcz was a site of a scientific celebration for our Society. Not only could we admire a fascinating scope of knowledge from paediatric oncology and haematology, but also we had a chance to appreciate charm of the city centre, including the most beautiful 360 panorama of cityscape in Poland – while standing on a bridge situated close to the Opera,” – Prof. Styczyński sums up the bebefits of the 11th PTOHD Congress.