SYNOPSIS
Acute lymphoblastic leukaemia is the most common malignancy in children. Although 5 years event-free survival rates reach 90%, some children still succumb to the disease and others achieve cure with significant late effects. Improving on this will require alternative treatments. This Grand Round will describe new options for refractory disease, and discuss some of the ethical aspects of embarking on these new treatment options.

One option is immunotherapy: using the immune system of the patient to kill leukaemia cells. B cell specific antibodies and CAR T cells are inducing responses and outcomes unmet before in refractory patients and represent a real breakthrough. However, like all chemotherapy, new forms of immunotherapy are not without side effects, and sending a patient down this difficult treatment pathway raises some important ethical questions about the balance of burdens and potential benefits for the child, and the capacity of parents to make truly informed decisions. Embarking on such therapy involves multiple stakeholders in a complex and multi-step process. It requires a team effort, without which it will fail. RCH is the only hospital in Australia to be involved in CAR T cell treatment. We need to be prepared as a team to face the challenges of this promising treatment.
SPEAKERS
Dr Francoise Mechinaud is Director of the Children’s Cancer Centre at RCH, and Lead Consultant in the Leukaemia and Bone Marrow Transplant Team. Prior to coming to Australia in 2010, Francoise was Head of the Paediatric Oncology Unit and stem cell transplant at the Nantes University Hospital in France. Francoise was Chair of the French Society of Pediatric Oncology and is interested in the organisation of paediatric cancer care and BMT, and in research. Francoise has been involved in many multi-centre research projects, including in leukaemia, bone marrow transplantation and innovative approaches to treatment of haematological malignancies.

Professor Lynn Gillam is the Academic Director of the Children’s Bioethics Centre at RCH, and Professor of Health ethics in the School of Population and Global Health at the University of Melbourne