A generation ago, childhood leukemia was a death sentence.
Today, the majority of kids diagnosed will live and that's especially true in Manitoba, a national leader in the use of cord blood for transplants in children suffering from leukemia.
"The kids are doing extremely well," said CancerCare Manitoba's Dr. Donna Wall.
"It's very rewarding," said Wall, who specializes in blood and marrow transplantation. She works with kids who wouldn't survive without a transplant but remembers a time when there was no hope for children with leukemia.
"The kids were surviving four to six weeks." That started changing around 40 years ago, Wall said.
"I remember seeing a young man in Boston as one of the first survivors of childhood cancer," she said.
"Now, a family with a child coming through the door with newly diagnosed leukemia has a well over 75 per cent chance of having that child, once they've completed that treatment, to never have that leukemia come back."
A generation ago, children diagnosed with childhood cancers had about an 80 per cent mortality rate. Today, it's 20 per cent, thanks partly to the clinical trials CancerCare takes part in with cancer centres around the world, she said.
"One of the reasons outcomes are improving so rapidly is that for the last several decades we collaborate across the world in developing and fine-tuning our treatments," Wall said.
"One of the other therapies we have is that of blood and marrow transplantation," she said. She's part of a team of doctors, nurses and therapists who work with kids from Manitoba, the North, Saskatchewan and northwestern Ontario.
A transplant requires a donor who is an immune match, said Wall. Only a quarter of the time the young cancer patient will have a sibling who's a good match, she said.
"It's quite common to be looking outside the family for an immune-match donor," she said.
CancerCare works with Canadian Blood Services and has access to 17 million potential donors worldwide.
"Members from our team have quite a few frequent-flyer miles," she quipped. "We will go very far to find the best donors for our patients," she said.
Despite the 17 million potential sources, there are still some patients who will not find a donor, said Wall. "For that, we have been developing cord blood for a donor source."
The cord blood obtained from the placenta has the immature features of a newborn baby, she said.
"Because of that, we can perform transplants using a less-complete immune match," she said.
It's especially helped aboriginal children. "Our First Nations kids are notorious for having unique immune types we're challenged to find matches for," said Wall.
Prospects for kids with leukemia started to improve in the 1970s, said Wall. "Most of the drugs are the same as those used in 1970s and '80s but we know how to use them much better," she said. "Clinical trials have guided us in optimizing their use," she said.
"The current breakthroughs relate to us being able to better understand the biology of cells -- how rapidly they're responding to chemotherapy."
That helps them determine when and how much chemo to give a kid, she said.
"Now, with some children we can predict they'll have over a 95 per cent chance of surviving leukemia without it coming back," she said. They can decrease the amount of chemotherapy with such a diagnosis.
"The other side is kids with really bad disease biology -- we can treat them more aggressively right away," said Wall.
The treatment works better and is easier for young patients to handle.
Leukemia treatment typically wraps up after three years, Wall said.
"After the first year, most kids are back in school. You will not recognize that those kids are in treatment for leukemia."
After the treatments, CancerCare Manitoba has a program to make sure kids are doing OK, she said.
Wall said her patients stay in touch for years: "It's unbelievably rewarding to get the pictures coming back of my patients as they're getting married, at their dance recitals... or holding up the big fish they just caught."