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Childhood cancer treatment in Germany
Types of cancer in children and adolescents
Cancer in children and adolescents is very rare. Cancers account for 1% of all illnesses in paediatric and adolescent patients. The most common form of cancer is leukaemia (31%); tumours of the central nervous system (brain tumours) come second (24%), followed by lymphomas (11%). Neuroblastomas (7%) and nephroblastomas (Wilms tumour, 5%) are also fairly common.
Leukaemias
- acute lymphoblastic leukaemia (ALL)
- acute myeloblastic leukaemia (AML)
Lymphomas
- non-Hodgkin lymphomas (NHL)
- Hodgkin lymphoma
Brain tumours
- low-grade gliomas
- high-grade gliomas
- medulloblastoma / embryonal non-rhabdoid CNS tumour / pineoblastoma
- ependymomas
Other types of solid tumours
- neuroblastoma
- Wilms tumour (nephroblastoma)
- Ewing sarcoma
- osteosarcoma
- soft tissue sarcomas
- retinoblastoma
Rare types of tumour
- haemangiomas
About the Centre for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD)
Each year, paediatric oncologists care for around 500 children and adolescents with cancer and blood disorders across all four centres for paediatric oncology, haematology and immunology at the university hospitals of Aachen, Bonn, Cologne and Düsseldorf. This makes the Centre for Integrated Oncology ABCD (CIO ABCD) one of the largest and leading institutions of its kind in Germany.
Teams of doctors, nurses, care assistants and paediatric psycho-oncologists with many years of experience in the interdisciplinary treatment of all malignant diseases support children and their families. 85% of children have been saved thanks to their experience, professionalism and well-established interdisciplinary cooperation.
A wide range of treatment options is available for young patients, including all the chemotherapy methods in use, stem cell and bone marrow transplantation, radiotherapy and specialised paediatric surgery.
In the paediatric oncology and haematology departments and in the outpatient units of the paediatric clinics at the four CIO sites, blood disorders and other cancers in children and adolescents up to the age of 18 are diagnosed in accordance with the treatment protocols of the Society for Paediatric Oncology and Haematology (GPOH), the International Society of Paediatric Oncology (SIOP) and the standardised treatment concepts of international specialist societies. Patients receive inpatient and outpatient treatment as well as day-clinic care.
Clinical and research areas of expertise of the paediatric oncologists at the Centre for Integrated Oncology Aachen Bonn Cologne Düsseldorf
- protocol-based treatment and research of germ cell tumours (treatment of intracranial germ cell tumours in children);
- allogeneic blood stem cell transplantation for patients with relapsed leukaemia and other systemic diseases;
- research into the long-term impact of childhood and adolescent cancer and its treatment on patients' quality of life.
- treatment and research of neuroblastoma, the most common extracranial solid tumour in children (clinical studies, experimental research, reference laboratory for molecular and immune markers);
- treatment and research of nasopharyngeal carcinoma in children and adolescents;
treatment of brain tumours; - clinical trials of new drugs for children and adolescents with malignant tumours.
Certified quality
The paediatric oncology centres within CIO ABCD are certified by the German Cancer Society (DKG) or are currently preparing for certification. They offer their patients interdisciplinary treatment in line with the latest scientific evidence. Close cooperation between specialists from every clinical discipline guarantees patients an accurate diagnosis and individually tailored therapy.
Paediatric diagnostic and interventional radiology
Paediatric radiologists accompany patients throughout the whole course of treatment, from the initial diagnosis through interim assessments and on to follow-up examinations after treatment has ended. The task of these diagnostic and interventional radiology specialists is to protect children carefully from radiation exposure and to make the experience as comfortable as possible for every child — from newborns to adolescents.
Stem cell transplantation and specialised radiotherapy
Bone marrow and blood stem cell transplantation is carried out in close cooperation with the paediatric departments and the oncology and haematology departments.
Autologous and allogeneic stem cell transplantation
Stem cell transplantation — the transplantation of the patient's own or a donor's haematopoietic stem cells — is one of the treatment options for a large number of patients with haematological diseases.
This form of therapy is a radical treatment and is intended for malignant tumour diseases. Delivering this complex treatment successfully requires the closely coordinated work of oncologists, nurses, psycho-oncologists, physiotherapists and many other specialists.
Conditions treated with stem cell transplantation
- aplastic anaemia;
- acute leukaemia (acute lymphoblastic leukaemia and acute myeloid leukaemia);
- chronic leukaemias (chronic lymphocytic leukaemia and chronic myeloid leukaemia);
- aggressive or indolent lymphoma;
- multiple myeloma;
- myelodysplastic syndromes;
- myeloproliferative syndromes (osteomyelofibrosis and, in exceptional cases, essential thrombocythaemia, polycythaemia vera);
- immunodeficiencies.
Depending on the type of disease and other accompanying circumstances, either autologous or allogeneic stem cell transplantation may be considered.
In an autologous stem cell transplant, the patient's own stem cells, collected beforehand, are transplanted back after high-dose therapy. This limits the harmful effect of high-dose chemotherapy on the bone marrow. The principle of allogeneic stem cell transplantation, by contrast, is that the diseased bone marrow is replaced by the stem cells and the immune system of a healthy donor. Besides replacing diseased stem cells with healthy ones, an immunological effect is also achieved which ideally acts against the underlying disease, for example the "graft-versus-host" reaction effect.
Centre for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD)
The Centre for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), founded in September 2018, brings together all the oncology clinics and centres of the University Hospitals of Aachen, Bonn, Cologne and Düsseldorf. All four members of the alliance are certified as oncology centres by the German Cancer Society (DKG). Around 200 clinics, centres and research institutes belong to the CIO ABCD structure. Holding the status of an oncology centre of excellence, CIO ABCD has been funded since 2019 by the German cancer aid foundation "Deutsche Krebshilfe e.V. Each year the Centre provides outpatient and inpatient care for more than 100,000 cancer patients.
The Centre for Integrated Oncology Aachen Bonn Cologne Düsseldorf is one of the largest and most respected centres in Europe for haematology, oncology, haemostaseology and stem cell transplantation in children and adults.
CIO ABCD also promotes and supports basic cancer research projects, translational oncology research and interregional collaborative clinical studies conducted by internationally recognised working groups and associations. This makes it possible to enrol cancer patients in clinical trials. At present the Centre is running more than
600 clinical
studies within 32 interdisciplinary project groups.
In addition, with the patient's consent, samples of removed tissue are stored in a so-called
biobank. As part of the CIO research projects, working
groups have been set up to study immunological and tumour processes.
The interdisciplinary cooperation of the CIO members is aimed at giving
cancer patients the greatest possible expertise and experience
through the collaboration of all its experts. At the CIO, research, diagnostics, treatment planning and follow-up
care, as well as education, training and continuing professional development, are centrally coordinated across the various disciplines and institutions.
Under the leadership of Prof. Dr. med. Tim H. Brümmendorf (Aachen), Prof. Dr. med. Peter Brossart (Bonn), Prof. Dr. med. Norbert Gattermann (Düsseldorf), Prof. Dr. med. Ingo Schmidt-Wolf (Bonn), Prof. Dr. med.
Jürgen Wolf (Cologne), a team of top-class specialists, clinicians and scientists works here, with particular expertise in the treatment of multiple myeloma, leukaemia and lymphoma.
The oncologists of the Centre for Integrated Oncology Aachen Bonn Cologne Düsseldorf have extensive experience in treating multiple myeloma, leukaemia and lymphomas.
- multiple myeloma;
- acute leukaemia;
- chronic myeloid leukaemia (CML) and other myeloproliferative neoplasms;
- chronic lymphocytic leukaemia and hairy cell leukaemia; Hodgkin lymphoma and non-Hodgkin lymphoma;
- sarcomas;
- myelodysplastic syndrome;
- bone marrow / stem cell transplantation;
- aplastic anaemia; lung cancer / bronchial carcinoma;
- tumours of the head and neck;
- melanoma.
CAR T-cell therapy at the Centre for Integrated Oncology Aachen Bonn Cologne Düsseldorf
CIO ABCD is one of the few institutions in Germany that offers CAR T-cell therapy – an innovative cell therapy for rare types of leukaemia and rare lymphomas, in which the patient's own immune cells "learn" to attack cancer cells. The cells of the immune system (T cells) are genetically reprogrammed so that they destroy tumour cells.
This new therapeutic approach to rare and very aggressive tumours uses what are known as chimeric antigen receptor T cells against two rare forms of leukaemia (blood cancer) and malignant lymphoma. CAR T-cell therapy (Chimeric Antigen Receptor T-Cell) involves collecting T lymphocytes from the patient's body by apheresis — a technique that separates the blood into its components and yields a defined number of lymphocytes. The cells are then modified so that they can recognise and attack tumour cells, and they are infused back into the patient so that, once reprogrammed, they recognise, attack and destroy the cancer cells.
Leukaemias and lymphomas that arise from a pathological change or malignant transformation of B lymphocytes share a common feature — they express a protein, or antigen, called CD19 on their surface. When cancer develops, the lymphocytes are unable to recognise this antigen and therefore cannot attack the cancer cells or stop them multiplying. Genetic engineering makes it possible to reprogramme lymphocytes and introduce genetic information so that these cells express a chimeric receptor, CAR-T, on their surface which recognises the tumour antigen (CD19) and destroys the malignant cells.
The procedure described is currently approved for use in the
following diagnoses: diffuse large B-cell lymphoma (DLBCL) and acute lymphocytic leukaemia (ALL). These are rare and very
aggressive tumours of the immune system which, without timely treatment, rapidly lead to death and which, before CAR T-cell therapy appeared, were treated with chemotherapy and radiotherapy.
Who is CAR T-cell therapy suitable for
At present it is indicated for children, adolescents and young adult patients (3–25 years) with refractory B-cell acute lymphoblastic leukaemia (ALL) and a poor prognosis. CAR-T 19 therapy is indicated for leukaemia patients who have had at least one relapse after a bone marrow transplant, or two to three relapses after other forms of treatment. In general, these are patients in whom no response to treatment can be achieved and for whom no conventional therapeutic option remains — chemotherapy or bone marrow transplantation.
A revolutionary breakthrough in the treatment of rare blood cancers and lymphomas
To use the medicines required for CAR-T therapy, a medical institution must demonstrate compliance with the standards and recommendations of the European Medicines Agency (EMA) governing the use of expensive and highly sensitive medicinal products. The institution must have sufficient experience in cell transplantation, along with the equipment, structures and technologies required (an apheresis unit, a haematopoietic progenitor cell transplantation unit, an intensive care unit). Until the summer of 2018, CAR-T therapy was available only to patients from EU countries as part of clinical trials. However, after the method was approved by the European Medicines Agency, its wider use became possible, including for international patients.
CIO ABCD is:
- > 225 doctors, including more than 40 professors;
- individually tailored therapy for > 15,000 patients a year;
- a close link between research work and clinical practice; the option of treatment in interdisciplinary outpatient oncology centres;
- its own bone marrow stem cell transplantation units for children and adults;
- a leading role in Germany in the development of anti-CD19 CAR T-cell therapy — tisagenlecleucel, or CTL019, Kymriah®, for the treatment of relapsed or refractory diffuse large B-cell lymphoma (DLBCL);
- clinical studies devoted to the use of CAR T-cell therapy for a broader range of diseases.
RECOMMENDED SPECIALISTS
Oncology, haematology, haemostaseology Professor Dr. med. Tim H. Brümmendorf
Aachen
Paediatric haematology, oncology, bone tumours in children Professor Dr. med. Udo Kontny
Aachen
Radiation oncology and radiotherapy Professor Dr. med. Michael Johannes Eble
Aachen
For a consultation or to order medicines, message our operator.
If the messenger did not open, add us via the phone number:
+4915208811019