Published on August 11, 2020
Immunotherapy and Chemotherapy for Pediatric ALL
Meet the Lehsing Family from Texas and their son Jaden who was diagnosed two years ago with pediatric acute lymphoblastic leukemia (ALL). They share their journey to his childhood acute lymphoblastic leukemia diagnosis. Jaden's doctor, Dr. Allison Grimes from UT Health Sciences San Antonio discusses the details of the type of leukemia Jaden has along with the pediatric ALL treatment history. Watch to hear the full story.
This is part one of a five-part series, which includes:
Transcript | Treatments for Childhood Acute Lymphoblastic Leukemia
Greetings, I'm Andrew Schorr, co-founder of Patient Power. I am an adult leukemia survivor. I'm joining you from Belmont, California, which is a little bit South of San Francisco and North of San Jose. We're going to take you to Texas, and I want to discuss acute lymphoblastic leukemia, ALL, in children, in young adults. So joining us is a family, where they've been affected by…There's Kristin and Garrett Leihsing, and also one of their twins, Emma. Hi, Emma, how are you doing? There's Emma with us. She's six years old. And they are in Bulverde, Texas, outside San Antonio. Now, let's move over to San Antonio, and you can unmute yourself. There's Dr. Allison Grimes, she is a Pediatric Acute Leukemia Specialist at the University of Texas Health Science Center in San Antonio in the MD Anderson branch there.
Okay, so let's start with that. So, Kristin and Garrett. So there you are two and a half years ago. You have twins who were four. Emma is one of them. And Jaden, I think, is taking a rest right now. But Jaden is Emma's brother. And he's not feeling well. Kristin, you took them to the ER, what was going on?
Well, actually, to begin with, we started recognizing that he had little red dots underneath his eyes, a little bit on his forehead and his chest. We didn't know what they were. We were out at the lake, so I didn't know if that was something like freckles were coming on, one of those things. But we really started to pay attention to him and recognized when he had a strong emotion, whether he was laughing really hard, he was coughing, whether he was having one of his moments, those little red dots would come up. And then they would disappear between two to three days.
So I took pictures of them, and it just didn't feel right. They didn't hurt him. It wasn't a rash, anything along those lines. And we took him into our family doctor here, and within 24 hours she ended up calling us and letting us know that we needed to head to University Hospital immediately. So, at that point, she did say that it was cancer, or that's what she really thought it was. So Emma went over to my in-laws' house and we've grabbed Jaden and we headed up there. We didn't find out until June 6 the actual type of his cancer as ALL.
And that was how long after you went to the hospital in the first place?
The very next day.
Okay. So, that is devastating. First, for you as adults, do you start crying? Do you fall on the floor? What do you do?
Well, I started crying. She was the rock. She, stone-faced... it's intimidating when you're sitting in a room with the three of us, and seven or eight individuals come in and stand around you in a circle. So you knew at that point it wasn't going to be good news. So as I was sitting there crying, not knowing what was coming next, she was really, Kristin here was really the rock and had a binder, and was writing everything down as I was trying to figure out what we're going to do next.
Right. Well, that's been a two and a half year odyssey, and my understanding is, Kristin, that Jaden, well, he's taking a little rest now, he's almost done with the standard ALL pediatric treatment he's had over two and a half years, right?
Correct, and we just found that out less than a month ago. So, that's a very exciting news.
It was supposed to be three years of treatment.
Yeah. So, two and a half is better.
So, Emma, you ready to have your brother back and forget about this cancer thing?
I'm so ready.
Yeah, you're so ready. Okay.
Because then we can jump in the lake water together, and ride the tube together.
Right and just play. All right. Let's meet your doctor, Dr. Allison Grimes. So, Dr. Grimes, it's a real shock, isn't it? And I know you've had to give families that news, we're talking about an uncommon cancer. But cancer is kids is uncommon, and this is often what it is. So, my understanding is, is that over the last many years actually, most of the time it's cured, correct?
That's absolutely right. Pediatric leukemia is the most common type of childhood cancer. And as you say, even though childhood cancers overall are rare, once you're looking at childhood cancers in general, leukemia is the most common occurring type. And of those, precursor B, or pre B, ALL, acute lymphoblastic leukemia, which is what Jaden has, is the most common subtype of the acute leukemias in children. If we were having this conversation back in the 1960s, pre B ALL in kids was almost universally fatal. In the 1970s, with the advent of maintenance therapy, and then in the '80s and '90s, with improvements and the combination chemotherapy drugs.
And then beyond that into the late '90s and early 2000s, improvements in supportive care and better detection techniques for children that had minimal disease that remained, we call that minimal residual disease (MRD), have allowed us to fine-tune how we treat upfront, identifying those that are at higher risk and significant improvements as a result in not only overall survival, which for standard-risk leukemia is between 90 and 95%, so that would be Jaden, and also improvements in... Yay. Improvements in quality of life for these kids. Because really, when we start therapy, the idea is that we're planning for the future.
Absolutely we want to cure the leukemia. We know that that is highly likely to occur, and so we also want to minimize late effects of the treatment at the same time as maximizing their survival.
We are now entering a really exciting era in transforming therapy for many childhood cancers, including pre B ALL. And we're now moving away from only backbone chemotherapy into combination chemotherapy and immunotherapy, not just for relapsed patients, which has been the case during the period of time that Jaden was being treated. So his treatment did not include immunotherapy. But now, upfront management for acute lymphoblastic leukemia for many patients actually includes immunotherapy, depending on your response to induction upfront.