On Monday July 8, Rob Pieters and his colleagues published results from a phase III study into the treatment of infants (less than 1 year old) with Acute Lymphatic Leukemia (ALL) according to the "Interfant-06" protocol. The Interfant protocol developed by pediatric oncologists at the Máxima now forms the basis for the treatment of all children with this type of cancer worldwide. According to an additional analysis the Netherlands has the best score in implementation of the protocol. The article is recently published in the leading Journal of Clinical Oncology (JCO).
There are various forms of Acute Lymphatic Leukemia (ALL), the most common form of cancer in children. Infants with ALL often have a DNA anomaly in a gene called "KMT2A": as many as 80% of infants with leukemia have this aggressive defect in their DNA. In over-one-year-olds the percentage has dropped to 1%.
Rob Pieters says, "When I used to work at the VUmc, we saw in the laboratory that the leukemia cells of infants were sensitive to a chemotherapeutic drug that was not often used in ALL. After more research, I then collated all countries in 1999 and discussed whether and how we could add the drug to the treatment. That's how we made a new treatment schedule. In the Netherlands, for example, the cure rate rose from 20% to 50%. The results were published in THE LANCET at the time." This related to the "Interfant-99 Protocol" that was used from 1999 to 2006. Protocol
Rob Pieters says, "In 2006 the successor to the protocol (Interfant-06) was introduced, with which we confirmed what we already knew from the Interfant-99 treatment. Western European and North American countries score about 10% better than other countries on the use of the same protocol. This may be due to the fact that we are better able to deal with the complications, while continuing the treatment all the same. Which means that fewer children die from side effects and fewer children from leukemia."
As part of the Interfant-06 treatment protocol, which was used in more than 600 babies from 2006 to 2016, a study was carried out in which a drug against acute myeloid leukemia was added to the treatment. Rob Pieters says, "The cell that causes leukemia in babies is a very immature stem cell. Given that such a cell can become both lymphatic and myeloid, we thought that the addition of a myeloid chemotherapy might help. Unfortunately, this experimental treatment wasn't more effective than the standard treatment."The Netherlands
The researchers also looked at the differences in survival rates between the 20 countries that followed the Interfant protocol. This data was not published in detail in the JCO article. Together with 3 other countries, the Netherlands scores the best worldwide, so our survival rates compare favorably with those in the other countries, while we all use the same Interfant protocol. According to Rob, this may be due to the fact that we are better able to deal with complications, while continuing the treatment all the same. All the oncologists and researchers whom we have to thank for this are now working in the Máxima.’ Basis
In conclusion Rob Pieters says, "This therapy now forms the basis for the treatment of this form of cancer around the world. We are now conducting pilot studies worldwide to add new drugs to this basic treatment. This contributes to our mission to cure every child with cancer!”