Pediatric Hematology/ Oncology

 

 

 

 

 

 

 

 

The Department of Pediatric Hematology/Oncology provides comprehensive medical care to children with cancers, hematological malignancies and non-malignant hematological disorders. Our team of doctors, comprising subspecialty physicians, surgeons, radiation oncologist, pathologist and intensivists, work closely to ensure cutting edge therapy to all children.The Department of Pediatric Hematology/Oncology is committed to providing highly specialized care for children with cancer and blood disorders through teamwork, conducting research and continuing education of patients, families, staff and integration with research.

 

 

Approximately 350 new cancer cases in children under 14 years of age are registered annually, making it one of the largest centers in the region. Approximately 40 percent of these patients are diagnosed with leukemia/lymphoma and 42 percent with solid tumors. In addition, the department runs a world class stem cell transplant facility, performing an average of 135 transplants every year, for patients with malignancies, hematological Immunodeficiency disorders and genetic disorders. Several programs exist in the pediatric hematology section with approximately 175 new cases are registered every year where children with hemoglobinopathies, bone marrow failures, bleeding and clotting disorders, get medical treatment.

 

The Department of Pediatric Hematology/Oncology has four sections, Leukemia/Lymphoma, Stem Cell Transplant, Solid Tumor and Non-Malignant Hematological Disorders Sections. In addition the pediatric hematologist oncologists work in tandem with the section of Immunology and is responsible for all of Immune disorders related stem cell transplants along with the department of metabolic and genetic disorders.

 

 

 

 

International Memberships

As part of our commitment to provide patients with the best possible treatment options, department maintains and implements treatment protocols from children oncology group (COG), making us the only COG member in the whole region. Besides we are a member of the Center for International Blood and Marrow Transplantation Research (CIBMTR) and European Society for Blood and Marrow Transplantation (EBMT)/JACIE.

 

Pediatric Hematology / Oncology Programs:

 

  1. Hemophagocytic Lymphohistiocytosis (HLH) Program

This is the largest program in the Kingdom both as diagnostic and therapeutic. King Faisal Specialist and Research Centre (KFSH&RC) is one of the leading Hospitals worldwide with large diverse forms of HLH.

 

  1. Neuro- Oncology /Retinoblastoma Program

 

Central Nervous System (CNS) tumors are the 2nd most common type of cancers and are the leading cause of morbidly and mortality in children. A multidisciplinary team of professionals is dedicated to children with brain tumors. Patients with retinoblastoma are managed through a joint program between King Khalid Eye Specialist Hospital with specialized neuro ophthalmologist and neuro pathologist.

 

  1. Car T-Cell Program

Car T-Cell is our new innovative program that will offer cure to children with various hematological malignancies who were otherwise deemed non-salvageable

 

  1. Non-Malignant Hematological Disorders Section’s Programs

Various comprehensive care programs are established under the non-malignant hematological disorders section, intended to treat the whole person and family by taking into consideration the physical, emotional, psychological, educational, financial and vocational factors. It provides access to a team of multidisciplinary health care professionals with different specialties.

  • Hemophilia/ Hemostasis Treatment Program
  • Bone Marrow Failure Treatment Program
  • Hemoglobinopathies Treatment Program

 

  1. PHO Fellowship Program

This is a highly competitive and sought after position, inviting trainees who want to pursue further sub-specialization in pediatric hematology/oncology under a vigorous training program. Successful candidates complete three years , with extensive clinical exposure in oncology (leukemia/lymphoma, solid tumor, Neuro-oncology, cancer genetics, new agents and innovative therapies), hematology (hemoglobinopathies, bone marrow failure and myelodysplasia, thrombosis/hemostasis and general hematology), and blood and bone marrow transplantation.

 

  1. SCT Fellowship Program

First of its kind in the whole region, this one year’s fellowship program provides extensive clinical training in all aspects of transplantation, including HLA typing, apheresis, cryopreservation, hematopathology and cytogenetics.

  

Sections:

Leukemia / Lymphoma

Being a quaternary care facility, we are catering not only the Kingdom of Saudi Arabia, but also the neighboring countries in this region. A child with leukemia usually requires 3 years of therapy.

During the year of 2017, we admitted almost 111 new patients of Leukemia and Lymphoma. This is in addition to 1731 OPD visits and 272 episodes of admissions to our Section in clinics and treatment area, for Leukemia and Lymphoma respectively.

Our 5 years’ survival rates for ALL and AML are comparable to the best in the world, such as COG and BFM groups. Since Leukemia’s make a substantial proportion of pediatric malignancies coupled with its favorable outcomes, it is always prioritized in children cancer institutes across the world.

During the last couple of years, our section has introduced many important treatment protocols, mainly from children oncology group (COG) to provide our patients with the best possible treatment options.

Research and Educational activities are integral parts of our section. We are actively involved in writing scientific papers and representing King Faisal Specialist Hospital and Research Center in different prestigious conferences like ASH, ASPHO, SIOP and SIOP Asia. To keep ourselves abreast with the Leukemia fraternity across the world, we have introduced Leukemia board where our physicians get acquainted with the rapid advancement in the field.

 Scope of Services

The section provides state of the art treatment to children from birth to less than 14 years of age with Acute Lymphoblastic Leukemia (ALL), Acute Myeloid Leukemia (AML), Hodgkin’s Lymphoma (HL), Non-Hodgkin’s Lymphoma (NHL), Myeloproliferative disorders (MDS) and other lymph proliferative diseases.

Based on gender, a child with lymphoblastic leukemia usually requires2- 3 years of chemotherapy, whereas in myeloid leukemia, and lymphoma, it can last for 6-8 months. The disease and its toxicities put our patients in a precarious situation which demands a highest degree of quality care.

Our section provides services such as home health care, outreach clinics and virtual clinics, to maintain a close follow –up with the patients, once discharged.

As part of our commitment to provide patients with the best possible treatment options, we work in tandem and implement international collaborative treatment protocols from children oncology group (COG) and BFM, making sure that our survival rates are comparable to the best in the world.

 

Research and Educational activities

Research and Educational activities are integral parts of our section. Several of our physicians and fellows lead innovative and leading research projects in the areas of leukemia, lymphoma and MDS.

We also conduct a Leukemia/Lymphoma board where doctors with different specialties meet regularly to discuss cancer cases and share knowledge, with a goal to determine the best possible cancer treatment and care plan for an individual patient.

Due to its high standards, our Leukemia/Lymphoma board participants get one CME credit for Saudi Commission for Health Specialties.

 

Non-Malignant Hematological Disorders

The Section of Non-Malignant Hematological Disorders is engaged in providing comprehensive clinical care to children with a wide range of non-malignant blood disorders under one of its three major programs: Hemostasis, Hemoglobinopathies and Bone Marrow Failures; acting as a national tertiary referral center for patients requiring transplant sharing clinical care of transplant patients'. Further, the sections round -the- clock consultative service provides prompt and appropriate hematology consultation throughout medical, surgical and ancillary clinical services at the institution; an integral part of the fellowship program that enabling a clinical environment for Hem-Onc fellows to develop skills and experience required in the diagnosis and management of hematological disorders.

 

Scope of Services:

The Section of Hematology is engaged in providing comprehensive clinical care to children with a wide range of Non-Malignant Blood Disorders under one of its three major programs: Hemostasis, Hemoglobinopathies and Bone Marrow Failures to children less than 14 years of age, within and beyond the Kingdom of Saudi Arabia.

Other major components of our services are home health care, outreach clinics and virtual clinics, to provide medical treatment to selected patients nearer to their home. Further, the section's around -the- clock consultative service provides prompt and appropriate hematology consultation throughout medical, surgical and ancillary clinical services at the institution.

 

Hemophilia Treatment Program

The Hemophilia treatment program is a comprehensive care program intended to treat the whole person and family by taking into consideration the physical, emotional, psychological, educational, financial and vocational factors. It provides access to a team of multidisciplinary health care professionals with different specialties.

 

Research and Educational activities

Research and Educational activities are integral parts of our section including hemostasis and hemoglobinopathies. Several of our physicians and fellows lead innovative and leading research projects in all major components of non-malignant blood disorders.

In order to keep abreast with the international medical fraternity, the section of non-malignant blood disorders is also working on various research projects, notably the wapps-hemo project. The Wapps-Hemo project and research network aims to make it easier to perform individual pharmacokinetic assessments on a reduced number of plasma samples by adoption of a population pharmacokinetics approach. The project will also gather data to substantially enhance the current knowledge about factor concentrate pharmacokinetics and sources of its variability in target populations.

 

Pediatric Non Malignant Blood Disorders Registry

Due to a penchant of consanguineous marriages, inherited blood disorders rate is higher in Saudi Arabia. Although there are various National cancer registries reporting incidence of different type of cancers globally, not a single comprehensive registry reporting incidence of non-malignant blood disorders is established. Therefore a comprehensive registry was conceptualized and developed in 2015, which is capturing data for Anemia and Hemoglobinopathies, Bone Marrow Failures, Hemostatis and Thrombosis and White Blood disorders. The aims of the registry are to collect demographic and clinical information of all newly diagnosed non- malignant blood disorders under the age of 14 years.

 

Fast – Track Pre-Bone Marrow Transplant (BMT) Clearance of Patients with Non-Malignant Blood Disorders (NMBD)

The section works hand in hand with the section of stem cell transplant and has a well-placed screening and selection project with objectives of increasing the number of transplants and reducing the Pre-BMT clearance time.

 

Moving Forward

 

1) Expansion of Pediatric Non Malignant Blood Disorders registry

Due to the great success of the non – malignant blood disorders registry in our institution, it will soon be expanded across the whole Kingdom. The aims of the registry will be to collect demographic and clinical information of all newly diagnosed non- malignant blood disorders under the age of 14 years. By virtue of this database the prevalence and effects of consanguinity are reported which will help in creating a better awareness amongst the families and pave the way for investing on a neonatal and pre-marital screening program.

 

2) Establishing a rare bleeding disorder registry

With a prevalence of 1 and 2 per 106 individuals, Rare bleeding disorders (RBDs) include the inherited deficiencies of fibrinogen, factor (F) II, FV, FV+FVIII, FVII, FX, FXI and FXIII. In contract to common bleeding disorders, most rare bleeding disorders are not as well characterized clinically and don’t have established treatment strategies. The aim of this registry will be to advance the understanding and care of people with rare bleeding disorders by strengthening our ability to diagnose, treat and care for patients with rare bleeding disorders.

 

3) Building an effective discharge planning program with referring hospitals

In collaboration with various referring hospitals across the Kingdom, our section is working on implementing the system of discharge planning which a process

used to decide what a patient needs for a smooth transfer from one level of care to another. An effective discharge planning reduces the rates of hospital readmission, helps in recovery and also provides care closer to home. It also helps in building the capacity of the referring hospitals, preparing them to meet the required challenges.

 

Stem Cell Transplantation

The Section of Pediatric Stem Cell Transplant (SCT) provides care for children in need of stem cell transplantation. The program performs an average of 135 transplants per year for patients with various malignancies and non-malignant hematological disorders as well as for immune deficiency and metabolic diseases. It is the largest SCT program in the region. The section is accreditation by Joint Accreditation committee - ISCT & EBMT (JACIE).  The program monitors 100-day mortality, end of year survival and benchmark these data with international reported outcome. The program also ensures donor health and product safety as per JACIE standards.  Our scope has now expanded by establishing the alternative donor program to ensure that every patient who is in need for stem cell transplant has a donor.

Scope of Services:

 The SCT section, of the Pediatric Hematology/Oncology Department, provides transplant services not only to patients within the Kingdom of Saudi Arabia, but also to neighboring countries within this region. We provide high level quality treatment and compassionate care to children from birth to less than 14 years of age who have been diagnosed with leukemia, lymphoma, Myelodysplastic Syndrome (MDS), Hemophagocytic Lymphohistiocytosis (HLH), Immune Disorders, Metabolic Disorders, Solid Tumors and Neuro-oncology and various hematological disorders.

Hematopoietic Stem Cell Transplant (HSCT) is a highly specialized procedure of transplanting mulipotent hematopoietic stem cells, usually derived from bone marrow, peripheral blood or umbilical cord blood. The cells may be procured from an autologous (patient’s own stem cells are used), allogeneic (stem cells from a donor) or syngeneic (from an identical twin) donor.

 

Autologous Transplant Process

In an autologous transplant, stem cells are collected from the patient themselves, harvested, frozen and stored, then infused back into the patient after intensive therapy. 

Allogeneic Transplant Process

In an allogeneic transplant, stem cells are collected from a matching donor and transplanted into the patient to suppress the disease and restore the patient’s immune system.

 

Stem Cell Quality Management System

 Stem cell transplant has become the mainstay of treatment for a number of congenital and acquired disorders. Despite making huge strides, it remains associated with substantial morbidity and mortality.

In order to minimize the risks associated with use of stem cells products and to ensure optimum human safety, it has been a standard practice for organizations to implement a quality management system. Use of quality management system ensures compliance to better products and services. As a result quality management has become an integral part of section of stem cell transplant. By assuming a multidisciplinary approach, it presents a role model to assess the value of a quality management system which defines equipment and infrastructures, responsibilities, release of products or services, training of personnel, acceptable criteria for admission and discharge, and requires implementation of standard operating procedures and continuous improvement strategies as key elements.

 

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International Memberships

As part of our commitment to provide patients with the best possible treatment options, we maintain membership and work in tandem with the Center for International Blood and Marrow Transplantation Research (CIBMTR) and European Society for Blood and Marrow Transplantation (EBMT) / JACIE.

 

Alternate Donor Program

The field of stem cell transplantation has taken a huge stride in the last few decades. To match this, our stem cell transplant section is working diligently to expend its alternate donor program, bringing more donors in the pool for those recipients who do not have a fully matched donor available. This is evident by an increase in the number of Haplo-identical and Matched un-related transplants that occurred during the last 3 or more years. It is estimated that our section performed more Haplo identical transplants in 2017 than many leading centers in Europe and North America.

 

SCT Fellowship Program

Section of SCT offers a one year’s fellowship program for physicians who desire training in clinical hematopoietic cell transplantation and clinical research. This incorporates autologous HSCT for solid tumors as well as allogeneic and unrelated donor HSCT and cord blood transplantation for hematological malignancies. This fellowship provides extensive clinical training in all aspects of transplantation, including HLA typing, apheresis, cryopreservation, hematopathology and cytogenetics.

 

Research Activities

Research and Educational activities are an integral part of our section. Several of our physicians and fellows lead innovative and leading research programs within the hospitals’ internationally acclaimed Research Institute, in the areas of hematological malignancies and benign hematological disorders for patients who underwent transplant for such disease management or cure. The section is actively involved in presenting scientific papers in CIBMTR, EBMT, ASH, Costem and other platforms. In collaboration with EBMT and CIBMTR study groups, our scientific papers are published in journals with commendable impact factors.

 

Transplant Data Center

The section has a well-established data center which maintains a comprehensive data on all transplanted patients, dating back to 1993 and currently has a cohort of 2500 patients.

 

Solid Tumors

The Section of Solid Tumors has three approved programs; Solid Tumors, Neuro-Oncology/Retinoblastoma and Histiocytosis. The Section accepts about 200 cases of newly diagnosed Solid Tumors each year. The Section coordinates the multidisciplinary treatment all varieties of pediatric solid tumors as needed for optimal care.

Our goal is to provide quality, compassionate care for children from birth to age 14 years with brain tumors, soft tissue sarcomas, bone tumors, Histiocytic disorders, Neuroblastoma, and retinoblastoma using a patient centric model and multidisciplinary care team approach while integrating new research efforts into treatment plans to allow patients access to the latest therapies and technologies.

 

The section accepted 125 new patients in 2015 (89 Solid Tumors, 36 Neuro-Oncology), 126 new patients in 2016 (82 Solid Tumors, 44 Neuro-Oncology), and 152 patients in 2017 (107 Solid Tumors, 45 Neuro-Oncology).

We are the only center in Asia to have an experienced pediatric surgery and urology physicians who are active members of the Children’s Oncology Group (COG) and have outstanding expertise in the management of children with cancer.

 

 Scope of Services:

The Section provides care for pediatric patients ages 0-13.99 years with solid tumors using a Patient Centric model. Our multidisciplinary team is composed of Consultants from Pediatric Oncology, Radiation Oncology, Surgical Services, Pathology, and Radiology, Assistant Consultants, Clinical Nurse Coordinators, Clinical Pharmacists, Nutrition, Pediatric Psychiatry, Nursing, Patient Relations, and Social Services. Our aim is to provide a comprehensive, multidisciplinary treatment and supportive care environment for the patient and his/her family during this difficult time.

The section provides care for a broad number of malignant and non-malignant conditions including brain tumors, retinoblastoma, renal tumors including Wilms' tumor, neuroblastoma, Rhabdomyosarcoma, non-rhabdo-soft tissue sarcomas, germ cell tumors, liver tumors, bone tumors including osteosarcoma and Ewing Sarcoma, histiocytic disorders such as Langerhan’s Cell Histiocytosis, and other rare tumors. It is highly preferred that patients are referred to us prior to any major surgery or treatment so that a complete and comprehensive plan can be offered the patient/family with the best chance for cure.

 

Duration of Care:

Patients are followed from the time of diagnosis through their treatment and remain in follow up for a minimum of 5 years after completing their treatment. Patients without any complications needing additional medical care at KFSHRC or those not on a clinical trial are referred back to their local medical facilities and primary care providers for continued follow up. There are certain tumors that need follow up longer than 5 years or if a patient is on a clinical trial, the follow up duration will be extended based on the study requirements.