Korea's new standardized treatment to turn tide in fight against child leukemia

Pediatric doctors across Korea joined forces to develop a new way of combating leukemia, the most common child cancer in the country that makes up around 40 percent of yearly cancer diagnoses.

A sculpture of late Samsung Chairman Lee Kun-hee installed at a lobby at Seoul National University Hospital's Children Hospital in central Seoul [JANG JIN-YOUNG]

Pediatric doctors across Korea joined forces to develop a new way of combating leukemia, the most common child cancer in the country that makes up around 40 percent of yearly cancer diagnoses.

Acute lymphoblastic leukemia (ALL), caused by the overproduction of lymphocytes in bone marrow, accounts for over 80 percent of leukemia diagnoses for Korean children — with around 250 diagnosed with ALL every year.

Developed countries have a recovery rate of nearly 90 percent for the cancer, yet the figure sits at around 80 percent in Korea.

To improve the chances of successful treatments, more than 50 doctors specializing in pediatric cancer co-developed a precision-based medical treatment that can be standardized to treat ALL patients nationwide regardless of their location.

The treatment has become available to patients recently.

Previously, doctors and patients relied on chemotherapy treatments developed overseas. As there was no integrated treatment scheme, doctors prescribed different medicines and took different approaches to treat patients.

An attempt to establish a united treatment scheme seemed challenging for the medical sector, but a donation of 300 billion won ($216 million) from late Samsung Chairman Lee Kun-hee (1942-2020) ended up being a game changer for cancer treatment.

The fund — actioned by Lee's family in 2021 — has given the medical community much-needed hope, helping develop treatment for child patients with pediatric cancer and rare diseases.

The standardized treatment was finalized last September after over 20 meetings where pediatric doctors nationwide shared their knowledge and takeaways from clinical analysis.

The doctors classified patients with ALL into five categories: the average-risk group, high-risk group, highest-risk group, infants group and recurrent group. They specified specific treatments for each patient group.

The Ministry of Food and Drug Safety also recently approved the treatment scheme.

Medical professors at the country's so-called Big 5 tertiary hospitals — Seoul National University Hospital, Asan Medical Center, Severance Hospital, Samsung Medical Center and Seoul St. Mary's Hospital — led research on the treatment scheme's effectiveness.

Kang Hyoung-jin, a pediatric professor at Seoul National University Hospital, explains the meaning of the donation from late Samsung Group chairman Lee Kun-hee to reporters in central Seoul. [JOONGANG ILBO]

Doctors also identified genetic mutations through whole genome sequencing using patients' genetic datasets, as well as those of their parents and grandparents. The pediatric patients received testing that detects measurable residual disease (MRD) using next-generation sequencing techniques, which can catch extremely tiny cancer cells.

The testing is usually conducted three times on average and sometimes more than 10 times throughout treatment. Its diagnostic quality is rated higher than previous methods, which include visual inspections using microscopes and antigen examinations.

Sixteen university-affiliated general hospitals nationwide conducted 1,700 sets of MRD tests on 500 patients. The donation from Lee funded the costs of the tests, with a single test being priced at 1 million won.

Whole genome sequencing is soon to be available at 11 hospitals nationwide. It was previously only available at the Big 5 tertiary hospitals.

Treating ALL using the next-generation sequencing method along with MRD detection has been unprecedented.

However, a lack of standardization and a high cost burden have prevented overseas medical professionals from trying out the groundbreaking treatment so far.

The MRD methodology combined with next-generation sequencing provides a more precise analysis and helps doctors better navigate treatment for patients.

In one case, a six-year-old boy was classified in the average-risk group after he was tested using previous methods. However, a detailed analysis using whole genome sequencing and whole exome sequencing showed that the boy had a risk factor that could require a stem cell transplant.

Afterward, MRD testing showed that his body had accepted his anti-cancer therapy well and that surgery was no longer needed. The new treatment and analysis meant the young patient anticipated a full recovery.

The newly devised scheme, which provided tailored treatment to each patient group, also led to more detailed predictions of treatment results.

“Medical experts specializing in pediatric leukemia developed an optimal remedy through cooperation, raising the recovery ratio to a similar level as developed countries,” said Kang Hyoung-jin, a pediatric professor at Seoul National University Hospital.

He added that medical professors are planning to devise treatment for other types of pediatric cancer by benchmarking the methodologies used to treat acute lymphoblastic leukemia.

Kang also promised to treat child cancer patients by reducing their intake of toxic medicines and increasing their lifespan. He also expressed his wish to contribute to society by aligning his efforts with the purpose of the donation from the former Samsung chairman.

Kang stressed that the donation enabled the research and development of the standardized treatment, as pediatric cancer tends to be sidelined in the public health system because the government often considers it a "minor cancer.”

“The treatment and research findings have laid the foundation for a sustainable pediatric medical system by establishing the treatment protocol for ALL — especially, Korea’s first,” Choi Eun-hwa, a medical professor specializing in pediatric infectious diseases at Seoul National University Hospital, said. Choi leads the Child Cancer and Rare Disease Project, which is operated by the fund donated by Lee.

Choi promised that the effort would continue to establish a system where pediatric patients in any part of the country can receive optimal treatment.

BY SHIN SUNG-SIK, LEE SOO-JUNG [lee.soojung1@joongang.co.kr]