About the Project

It is well documented that acute lymphoblastic leukaemia (ALL) represents the majority of cancers diagnosed in children under the age of 15 in economically developed countries. However, there is a paucity of reliable data relating to global variations in the incidence and mortality of the disease. Furthermore, although over the past few decades remarkable advances have been made in understanding the underlying biology of ALL, coupled with improved treatment regimens, less progress has been made in identifying specific risk factors involved in disease initiation and development. Perhaps more important is the fact that despite these advances, survival rates also demonstrate marked global variation, and it is not clear whether these differences are totally attributable to treatment accessibility and follow-up care, or whether the existence of other comorbidities and genetic variability in drug metabolism also play a part.

Clearly, we still have much to learn about childhood leukaemia, and in trying to further our knowledge about what causes the disease and to improve prognosis we are faced with many challenges. These are related not only directly to the complexity of the disease itself but also to the recognition that some questions may simply be unanswerable and that pursuing answers to others may require adapting protocols and investigations to the local environment, rather than creating a one-size-fits-all model.

Without a doubt, the issue of limited resources is the biggest challenge faced in many countries. However, it is not just a case of providing money to fund the implementation in low-income countries of treatment protocols developed in high-income countries. Establishing the infrastructure and support mechanisms required by families to allow their child to be treated and cared for while trying to keep to a minimum the devastating and catastrophic effects on family life are much more fundamental problems to address. Simple examples include situations where parents are not able to support and feed the rest of the family due to the costs of treatment, or are not able to work because they need to look after their child and take them to the clinic. In addition to this, and perhaps often overlooked, is the recognition that in some countries childhood leukaemia is not the biggest threat and problem faced by many families.

The purpose of the project outlined here is to provide new strategies for future investigations that will not only further our knowledge and understanding of the disease but also, importantly, establish a framework in low-resource countries by which to provide help in dealing with the burden of the disease. To achieve these goals, the Global Acute Leukaemia network (GALnet) was established in February 2013.