Top Docs: 5 facts about childhood leukemia

Of all the illnesses that can strike a child, leukemia is among the most dreaded. A form of cancer, leukemia is diagnosed each year in nearly 4,000 U.S. kids younger than 15, accounting for about a third of all cancer cases in children, according to the Leukemia & Lymphoma Society.

The group notes, however, that great advances have been made in treating the disease and that new treatments offer even more hope.

Here's what you should know:

1. DEATH RATES FROM LEUKEMIA HAVE FALLEN DRAMATICALLY

The improved treatment of childhood leukemia is "one of modern medicine's true success stories," said Dr. Dominick P. Sabatino, director of pediatric hematology/oncology at Nassau University Medical Center in East Meadow.

In the 1950s, he said, the average patient lived for less than a year after being diagnosed. Over the next decade, chemotherapy boosted that number to four years, and advances over time have continued to save lives.

"It's been transformed from an incurable disease to a treatable disease, with many children surviving more than five years," Sabatino said. "Many are now young adults and continue to do well."

Today, said Dr. Lawrence C. Wolfe, associate director of hematology and safety in the division of pediatric hematology / oncology at the Steven and Alexandra Cohen Children's Medical Center of New York, "If your child has the diagnosis of any type of leukemia, there is almost always a chance for cure."

2. CHEMOTHERAPY IS STILL THE MAINSTAY OF TREATMENT

Treatment of acute lymphocytic leukemia, the most common form, most often consists of a combination of four chemotherapy drugs in various doses and regimens, Wolfe said. "Treatment usually lasts about three years, and the more intensive part of treatment occurs during the first six months, with the remaining 21 / 2 years as outpatient treatment," he said.

In recent years, Wolfe said, doctors have been able to boost survival rates by adjusting treatments for a variety of factors, such as age and details about the disease revealed in lab tests.

Experimental treatments -- medications that are still in the research stage -- are used to treat rare forms of leukemia and types that don't respond to existing chemotherapy regimens, Sabatino said.

3. STEM CELL TRANSPLANTS MAY BE AN OPTION

"As advances in stem cell treatments have created more safety in the process and the availability of possible donors from outside of the patient's siblings, the use of bone-marrow transplant has been added to the armamentarium of physicians treating acute lymphocytic leukemia," Wolfe said. Through bone-marrow transplants, kids with leukemia receive stem cells that produce new blood cells. That can allow leukemia (a kind of blood cancer) to be cured.

"Patients who have their leukemia reappear during treatment or less than six months after treatment have a 40 to 60 percent chance of finally achieving cure with a bone-marrow transplant," Wolfe said. In addition, he noted that "currently, there are experimental protocols looking at transplant as part of the initial treatment in our most difficult group to treat, the children who present under a year of age."

4. LEUKEMIA TREATMENT TAKES A VILLAGE

Don't expect a child to see one or two doctors during treatment. "The child needs to be treated at a center that is equipped to handle the many complications of the treatment and of the leukemia," Sabatino said. "The treatment team must include a pediatric hematologist/oncologist, general pediatricians, genetic services, good blood bank services, a social work team, an experienced nursing service and many other disciplines, subspecialists and services."

Given this, communication is key, he said. The family "must know the names of the drugs, complications of the treatment, the rationale for doing procedures, etc.," Sabatino said. "This approach, in my experience, leads to a much smoother course and makes what could be an intolerable experience into a tolerable one, oftentimes with a very successful outcome."

5. NO TREATMENT IS GUARANTEED TO CURE LEUKEMIA

"Leukemia is a highly curable set of diseases, but not all leukemias are the same and not all will be cured -- even those that fall into the 'lesser risk' category," said Dr. Robert Parker, division chief of pediatric hematology/oncology at Stony Brook University. "Parents must understand that physicians cannot guarantee an outcome and that there are still facts about leukemia and treatments that are not known."

Nonetheless, leukemia treatments are standardized, for the most part, Parker said. That means there should be little if any difference between treatment centers.

"If a child is being treated at a Children's Oncology Group institution -- this is a group of over 200 children's oncology programs -- and the treatment follows a Children's Oncology Group or similar treatment protocol, the parent can feel comfortable that his or her child is receiving modern, state-of-the-art treatment," Parker said.

Pediatric specialists\

PEDIATRIC HEMATOLOGY-ONCOLOGY

Dr. Jeffrey M. Lipton

Steven & Alexandra Cohen Children's Medical Center

Div. Hematology/Oncology

269-01 76th Ave., Rm. 255

New Hyde Park; 718-470-3460

Dr. Robert Parker

Stony Brook University Medical Center

Dept. Pediatrics, HSC T-11, Rm. 029

Stony Brook; 631-444-7720

Dr. Arlene Redner

269-01 76th Ave., Rm. 255

New Hyde Park; 718-470-3460

Dr. Dominick P. Sabatino

Nassau University Medical Center

Dept. Pediatrics

2201 Hempstead Tpke.

East Meadow; 516-572-6177

Dr. Mark E. Weinblatt

Winthrop University Hospital

120 Mineola Blvd., Ste. 460

Mineola; 516-663-9400

Dr. Lawrence C. Wolfe

Steven & Alexandra Cohen Children's Medical Center

Div. Hematology/Oncology

269-01 76th Ave.

New Hyde Park; 718-470-3460

PEDIATRIC INFECTIOUS DISEASE

Dr. Leonard Krilov

120 Mineola Blvd., Ste. 210

Mineola; 516-663-4600

Dr. Sharon Nachman

Stony Brook Univesity Medical Center

Dept. of Pediatrics, T-11, Rm. 031

Stony Brook; 631-444-7692

Dr. Lorry Rubin

269-01 76th Ave.

Div. Infectious Disease

New Hyde Park; 718-470-3480

Dr. Sunil K. Sood

Infectious Disease

269-01 76th Ave.

New Hyde Park; 718-470-3480

PEDIATRIC OTOLARYNGOLOGY

Dr. Michael Mendelsohn

990 Stewart Ave., Ste. 610

Garden City; 516-222-1881

Dr. Lee P. Smith

430 Lakeville Rd., Lower Level

New Hyde Park; 718-470-7550

PEDIATRIC PULMONOLOGY

Dr. Janis Schaeffer

3003 New Hyde Park Rd.,

Ste. 204

New Hyde Park; 516-488-7575

Dr. Alfin G. Vicencio

Cohen Children's Medical Center

Pulmonology/Cystic

865 Northern Blvd., Ste. 103

Great Neck; 516-622-5280

PEDIATRIC RHEUMATOLOGY

Dr. Beth Susan Gottlieb

Div. Pediatric Rheumatology

269-01 76th Ave.

New Hyde Park; 718-470-3530

PEDIATRIC SURGERY

Dr. Charles V. Coren

320 Post Ave., Ste. 101

Westbury; 516-997-1199

Dr. Stephen Dolgin

Cohen Children's Medical Center

Pediatric Surgery

269-01 76th Ave., Ste. 158

New Hyde Park; 718-470-3636

Dr. Andrew Hong

Steven & Alexandra Cohen Children's Medical Center

269-01 76th Ave., Ste. 158

New Hyde Park; 718-470-3636

Dr. Edmund Kessler

1000 Northern Blvd., Ste. 250

Great Neck; 516-498-9000

Dr. Thomas Kang-Ming Lee

37 Research Way

East Setauket; 631-444-4545

Dr. Vincent Parnell

Steven & Alexandra Cohen Children's Medical Center

Pediatric Cardiothoracic Surgery

26901 76th Ave.

New Hyde Park; 718-470-7350

Dr. Richard J. Scriven

37 Research Way

East Setauket; 631-444-4545

Dr. Steven Stylianos

269-01 76th Ave.

New Hyde Park; 718-470-3636

How they were picked

Castle Connolly Medical Ltd. is a health-care research and information company founded in 1991 by a former medical college, board chairman and president to help guide consumers to America's top doctors and top hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of top doctors and the medical leadership of leading hospitals.

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Careful screening of doctors' educational and professional experience is essential before final selection is made among those physicians most highly regarded by their peers. The result -- Castle Connolly identifies the top doctors in America and provides the consumer with detailed information about their education, training and special expertise in their paperback guides, national and regional magazine "Top Doctors" features and online directories. Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors. (Newsday is not part of the selection process.)

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