Pediatric leukemia accounts for about 30 percent of all childhood cancers. It primarily strikes at a young age, and its treatment requires an infrastructure beyond imagination. From the very first bone marrow test, children require sedation. The younger the child, the more challenging blood collection and intravenous access become, making it impossible without highly skilled personnel. Because pediatric leukemia has different mechanisms of onset and congenital factors compared to adult leukemia, it requires precise interpretation by specialists in pediatric pathology and genomic diagnostics. In other words, diagnosis alone demands several times more resources and effort. Despite this, there was a grim era when such processes were calculated simply as “0.2 patients” per adult weight equivalent. Frankly, I didn't anticipate it being this severe at the start. I somehow ended up here, and I've come too far to turn back now.

Ironically, the recent medical crisis brought about change. Pediatric hematology-oncology has always been a challenging field (difficult, dangerous, and demanding). However, as even the remaining staff left one by one, regional hospitals found it increasingly difficult to endure. Ultimately, the government began designating and supporting regional pediatric cancer hub hospitals. Although most of the new hires are contract workers, at least having colleagues to work alongside provides a temporary solution. Furthermore, a system to cover the deficits of children's hospitals has been implemented, although not entirely. Pediatrics, which was always treated like a criminal due to chronic deficits, now feels the sharp gaze of hospital management a little less. Whether it's unfortunate or fortunate, the public is now aware that pediatrics suffers from a shortage of personnel.

However, improving public perception remains a distant goal. There's no guarantee the system won't disappear, and the deficit compensation rate is insufficient. Most importantly, pediatric patients are unique beings undergoing the special processes of growth and development. To properly treat a single patient, collaboration is required from surgery, anesthesiology, radiology, radiation oncology, and other departments with extensive pediatric experience. Dedicated nursing staff and specialized pharmacists are also essential. Above all, a working environment must be established where these specialists can remain and work steadily. Yet, the system still harbors the simplistic notion that “assigning just one or two doctors will solve the problem.” Without breaking away from this mindset focused solely on efficiency, a fundamental solution remains elusive. Going forward, long-term, sustained support encompassing multidisciplinary capabilities is urgently needed.

Pediatric leukemia treatment has made remarkable strides over the past several decades. Advances in precision diagnostics based on next-generation sequencing (NGS) and NGS-based minimal residual disease (MRD) testing, which sensitively detect residual leukemia cells post-treatment, have enabled more refined risk-based treatment strategies.

Cyclophosphamide-based family-related haploidentical hematopoietic stem cell transplantation is actively performed in high-risk pediatric leukemia patients, reducing donor search times and broadening eligibility. Blinatumomab is incorporated into initial therapy, significantly improving disease-free survival rates. Clinical trials are actively exploring the expansion of CAR-T cell therapy beyond the existing relapsed/refractory patient population to earlier treatment lines.

Furthermore, the recent U.S. FDA approval of the Menin inhibitor revumenib for KMT2A rearranged leukemia is opening new avenues for targeted therapy. Globally, precision diagnostics, personalized medicine, immunotherapy, and novel targeted therapies are converging, rapidly transforming the treatment paradigm. In Korea, however, indications for pediatric patients and insurance coverage remain limited, necessitating efforts to bridge this gap.

Children with leukemia engage remarkably actively in their treatment journey, enduring multiple crises. Medical professionals feel deep fulfillment as they complete this long journey alongside the child and family. Remarkably, a significant number of survivors later become medical professionals or social workers, returning to support patients.

Their time in the hospital could have remained a memory they'd rather forget, but instead, they transform their painful experience into a source of strength and choose a path to help others. This virtuous cycle provides immense inspiration to the current generation of medical professionals and serves as the driving force to continue walking this path.

However, for this virtuous cycle to continue, the role of the state is paramount. Just as senior doctors paved the way for pediatric leukemia treatment in our country by introducing advanced therapies from developed nations, the government must now step forward to establish a more robust institutional foundation.

Expanding indications for innovative treatments, improving insurance coverage, and closing the treatment gap between rural areas and metropolitan regions are tasks that can no longer be delayed. A child's chance at life should not depend on where they were born or their parents' economic circumstances. Protecting children's lives is the responsibility of society as a whole, and the state's investment and support are not optional—they are an obligation. I expect more fundamental policy support for the children receiving treatment in wards right now and for the children yet to be born.