Paediatric Oncology and Haematology

Childhood cancer is the leading cause of child mortality due to illness in children over one year old. At present, we have managed to ensure that survival is around 80%, but we are working every day to make progress in research so we can cure all children and adolescents with cancer and also reduce the after-effects of short and long-term treatment.

According to data from the Spanish Register of Child Tumours (RETI), our department is one of the leading centres in the country, and a reference centre for procedures such as the transplant of haematopoietic progenitors or stem cells (with over 1300 performed) and for pathologies such as sarcomas, neuroblastoma or bone-marrow failure syndromes.

We are also a reference centre for European Reference Networks for paediatric cancer, non-malignant haematology (EuroBloodNet) and paediatric transplant (TransplantChild). This is the department with the most accumulated experience in the country, with more than 3400 patients with child cancer treated over the last 40 years and our rates of cure are equivalent to international centres of excellence.

The department has a long history of receiving patients from other centres in order to treat complex cases, such as patients with rare cancers, highly complex surgery, transplant haematopoietic progenitors and clinical trials phase 1 and 2.

The most common types of cancer we treat are leukaemia, brain tumours, lymphomas, neuroblastomas, bone and soft tissue sarcomas, kidney and liver tumours. We also treat non-malignant haematological pathology in children and adolescents, with particular focus on drepanocytosis (sickle cell anaemia), where we are the reference centre for Catalonia’s screening programme, and congenital bone-marrow failure syndromes such as Fanconi’s anaemia.

Healthcare activity

Portfolio of services

Our department deals with all malignant onco-haematological diseases (all types of child cancer) and non-malignant haematological (blood) diseases. These include:

• Paediatric Oncology Unit: treatment of brain tumours, lymphomas, retinoblastoma, neuroblastoma, soft tissue sarcomas, bone tumours, Wilms and kidney tumours, hepatoblastoma and liver tumours. Attention to non-malignant vascular disease. Attention to hereditary predisposition to cancer syndromes.
• Paediatric Haematology Unit: attention to leukaemia, myelodyplastic syndromes, non-malignant white (congenital and acquired neutropaenia), red series (congenital and acquired haemolytic anaemias) and platelet series (congenital and acquired thrombopenias) pathologies.
• Haematopoietic Progenitor Transplant Unit: care for patients requiring transplant due to malignant diseases (leukaemia) or non-malignant diseases (immunodeficiencies, metabolic diseases, acquired aplasia and other congenital bone-marrow insufficiency, haemoglobinopathies (sickle cell anaemia and thalassaemia)). The Transplant Unit performs around 40-50 transplants a year. We perform all kinds of transplants, and are pioneers in complex cases, such as non-related donor and umbilical cord blood transplants. Our centre was the first in Spain to obtain JACIE accreditation (Joint Accreditation Committee ISCT and EBMT), the most prestigious accreditation in the medical field, becoming the first exclusively paediatric unit in Spain to receive the accreditation.

The treatments available include:

• All types of chemotherapy, new biological therapies, immunotherapy, molecular therapies.
• All types of transplant of haematopoietic progenitors (autologous and allogenic), cell therapy and CAR-T therapy.
• Radiotherapy (including conventional radiotherapy, stereotactic). Protontherapy available according to CatSalut criteria.
• Metabolic therapy with MIBG and radioiodine.
• High-complexity cancer surgery.
• Multidisciplinary approach including tumour committees, psycho-oncological support, social work, physiotherapy and specialised rehabilitation.

We have an onco-haematologist on duty 24 hours a day, 365 days a year for oncological emergency care and with specialised multi-disciplinary consultations on genetic counselling and predisposition to child cancer, cancer in adolescents and young adults and in phase 1-2 clinical trials.

Facilities

The Day Hospital dedicated to Paediatric Oncology and Haematology (the ground floor of the Children’s Hospital) handles over 4000 visits a year for treatment and over 11000 medical visits. Regarding hospitalisation (1st floor of the Children's Hospital), we carry out about 700 discharges per year.

Our service has 24 hospitalisation beds and 7 transplant beds, 6 doctor's offices and 10 Day Hospital facilities. We also have a sedation office for onco-haematological patients. Our experience, staff and advanced technological prowess mean our department can offer multidisciplinary, comprehensive care to patients and their families, covering all diagnostic procedures and offering the most advanced treatments.

Our team includes oncologists and paediatric haematologists, nurses specialised in haemato-oncology and paediatric transplants, psycho-oncologists, social workers, volunteers; as well as a large multidisciplinary team including radiotherapy, pharmacy, rehabilitation, physiotherapy, nutritional support and all surgical specialities to perform highly complex surgery (paediatric oncology surgery, paediatric neurosurgery, traumatology and paediatric orthopaedics, among others) and doctors; in collaboration with the whole Vall d’Hebron Campus for the availability of high technology and complex procedures.

Care for children and the family

Our main goal is to provide the best care to our patients and their families. To provide more human attention, we develop projects with professionals, families and associations, by incorporating new technologies, such as virtual reality, new devices to administer chemotherapy (Superbox project), play care. Thanks to the invaluable collaboration and support of AFANOC, we can carry out music therapy and art therapy activities.

Research

The Research Group in Child Cancer and Haematological Pathologies is focussed on the research of new treatments and biomarkers for child cancer and haematological diseases. Our department, in its role as an international reference centre, actively participates in and leads initiatives in many international scientific societies, such as the International Society of Paediatric Oncology Europe [SIOPE], European Society for Blood and Marrow Transplantation (EBMT) and Center for International Blood and Marrow Transplant Research (CIBMTR), European Paediatric Soft Tissue Sarcoma Group (EPSSG), European Network for Neuroblastoma Research (SIOPEN), leukaemia (international BFM group) and in new drugs (Innovative Therapies for Children with Cancer (ITCC)).

At the national level, Vall d’Hebron leads the bone-marrow failure, soft tissue sarcoma and personalised medicine groups of the Spanish Society of Paediatric Haematology and Oncology (SEHOP). We have active collaborations with international centres such as Royal Marsden (London), Dana Farber (Boston), Gustave Roussy (Paris) and Princess Maxima (Utrecht).

The research group includes three laboratories (sarcomas - Dr. Josep Roma, neuroblastoma and brain tumours - Dr. Miquel Segura and minority anaemias Dr. Mar Mañu), and three clinical research programmes: Clinical Trials Unit (Drs. Raquel Hladun and Lucas Moreno), haematology, cell therapy and transplant programme (Dr. Cristina Diaz de Heredia) and personalised medicine programme (Drs. Aroa Soriano and Lucas Moreno).

The clinical trial unit has over 50 clinical trials in all phases for paediatric cancer, with over 30 phase 1-2 trials of new drugs, including molecular therapies, immunotherapy and cell therapy, such as CAR-T. We receive patients from centres all over Spain to facilitate access to new drugs in cases of cancers where conventional treatment has failed. The personalised medicine programme provides access to the genetic sequencing of patients' tumours to seek new treatments.

Education and training programmes

Every year, our centre welcomes 18 new residents in the Paediatrics specialism and its specific areas. During their training period, they rotate through Paediatric Oncology and Haematology for three months. We also receive external rotations from other national or international centres that wish to further their knowledge in this area, as well as medical students from the Autonomous University of Barcelona completing work placements during the 4th and 6th years of their degree.

The Department also has a 2-year training programme in paediatric oncology and haematology and the transplant of haematopoietic progenitors for doctors who have completed their residency whose aim it is to acquire highly specialised training. Lastly, together with the research institute (VHIR) and the Autonomous University of Barcelona, several master’s, doctoral programmes and postgraduate courses are operated, and we receive students from other disciplines such as nursing, psychology and other biomedical sciences.