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Anastasia Balezdrova

"Marianna Vardinogianni-Elpida" Oncology Centre that was opened in the autumn of 2012 is perhaps one of the most modern oncological hospitals for children worldwide. The hospital has three haematology-oncology wards, one ward for bone marrow transplants as well as medical consulting offices outside the wards and rooms for day treatment. They are attended by children, who have been discharged from hospital, to undergo specific treatments once a month.

The nice building of the centre also houses a school, although the lessons often take place in the rooms of the children. The hotel part of the complex has 30 rooms that accommodate children from the country and their mothers, and sometimes fathers, who find it hard to bear the cost of a stay away from home that often lasts several years.

A few months ago, a bank of bone marrow donors was opened in the centre in order to provide transplants for the young patients who suffer from various types of cancer. Director of the transplant unit and scientific head of the bank of bone marrow donors Stelios Grafakos speaks before GRReporter about the hospital that is a private donation to the state and where the treatment of children is absolutely free.

Mr. Grafakos, what is the capacity of the hospital? How many children affected by cancer can undergo treatment in it?

The hospital consists of all the wards that deal with child cancer. In particular, we have three paediatric haematology oncology clinics and a transplant ward. Each ward has the capacity to treat 28-30 children. The number of hospital beds in the transplant ward is 15. The hospital meets 80% of the needs in Greece. There are children's oncology wards in Thessaloniki (2 units) and Heraklion in Crete too, which also work very well but they can admit a lower number of patients.

The hospital is part of "Aghia Sofia" Children's Hospital. It is a donation from "Elpida" association to the Greek state and its current requirements are met by the national health system. This means that the parents of sick children pay nothing for their treatment because all costs are covered by the state.

Are there cancers that are most common in children?

Cancer in childhood is different from cancer in adults, i.e. it occurs in a different manner. While the environment plays a major role in adults, as the smoker faces a high risk of falling ill with lung cancer or the person who does not eat properly is threatened with colon cancer, things in children are different. In them, genetic factors play a primary role, i.e. the liability of the child to develop a cancer, without this meaning that there is a heredity factor. Therefore, cancer in childhood, such as leukaemia, develops rapidly. However, children are very responsive to treatment. As a result, in 80% of the cases the treatment of leukaemia in children is successful. The corresponding rate in adults is 30%.

How quickly do you act once you have diagnosed the patient?

Typically, we act within a week. The treatment begins immediately after the first tests. We follow protocols that are applied in many Western and other countries and the results are very good, as I have already mentioned.

The hospital opened a bank of potential bone marrow donors earlier this year. Would you tell us about it?

I would like to say first that the transplantation of bone marrow or stem cells is aimed at fighting especially dangerous diseases. As I said, 80% of children affected by leukaemia undergo a successful treatment by chemotherapy. The remaining 20% whose condition is bad from the start or in whom the disease is recessive undergo transplantation because medicines cannot solve the problem. Such diseases are high-risk leukaemia, immune deficiency, thalassaemia, and the like.

To proceed with the transplantation we have to find a suitable donor, i.e. one whose cells have a genetic makeup similar to that of the patient. We first seek a donor among the family members, but the probability of finding a compatible donor, usually among the siblings, is in the range of 25-30%. Therefore, there is no suitable donor for the majority of the patients among their family members and we have to look for one.

Fortunately, today there are donor banks in many countries with more than 23 million donors, volunteers, from around the world.

Since their number in Greece was small and the level of awareness on the subject was low, three years ago the University of Patras created the first donor centre called "Donate Life" that already has 5,000 registered donors. The broader initiative, however, started 5-6 months ago with the establishment of "Orama Elpidas" association by "Elpida" and its founder Marianna Vardinogianni. The main objective of the association is to create a donor bank to meet the needs of patients in Greece. So far 4,500 volunteers have registered and we hope to have 100,000 volunteers within five years in order to be able to find a suitable Greek donor for all those patients who do not have one among their family members. Today, in 90% of transplantations that take place using an "external" donor the transplants come from Germany, Italy and other countries.

Does this mean that the Greek donor bank will provide transplants for the needs of patients from other countries?

Like all donor banks ours cooperates with the international bank of volunteer donors too. Every citizen who is registered as a donor is aware that he or she will provide transplants for the treatment of a patient in every country. This act goes beyond state boundaries. If we have a compatible donor here, we provide transplants for patients wherever they are located the same way we accept transplants from other countries.

Does the donor have to travel to the particular country?

No, he or she does not have to. The donor gives blood or spinal cord in the country where he or she lives. Then subsequently, the donor bank sends the transplant to any country in the world.

Would you describe the process by which a person can become a donor?

Firstly, those who want to be donors should have the desire to help others, be altruistic and aged between 18 and 45 years, as the younger the donor, the better.  When the donor is a sibling of the patient, he or she can provide bone marrow, even if he or she is over 70 years old.

The donors give some blood or saliva initially to enable us to determine their DNA profile and tissue identity and to make tests to determine the histocompatibility antigens. The applicant signs a document with which he or she agrees to become a donor.

The bank sends his or her data to the Hellenic National Transplant Organization and the international donor bank. If there is a patient whose DNA profile is similar to that of the donor, we call the donor, explain the process again and if the person still wants to provide a transplant we determine the day of the transplantation in the relevant country. The person has to come to us a day earlier to provide the transplant.

There are two ways to take stem cells. In the past, the usual practice was the extraction of bone marrow from the bones of the pelvis through a puncture. Today this is done only very rarely. In the majority of cases, the procedure is as follows: the donor has a subcutaneous injection in order to inject a substance that increases the number of white blood cells. This substance is found in the human body and it does not threaten it at all. Then subsequently, a special device similar to those used for blood donation is switched on to separate the stem cells. The process lasts about 2-3 hours and does not pose a risk to the donor.

You said that the treatment is successful in 80% of the cases. What happens when it fails?

The result depends on the general condition of the patient and on the particular disease. For example, in patients with thalassaemia who have to undergo a blood transfusion every 15 days the treatment at our hospital is successful in 95% of the cases. In leukaemia the success rate is 65% and in immunodeficiency 75%.

A major problem in transplantation is complications that may be direct, such as a severe infection caused by the reduced strength of the organism. However, there is the likelihood of the child's body rejecting the transplant. This is a common problem with aplastic and Mediterranean anaemia and a rarer one in leukaemia.

In the case of rejection, our first action is to look for a donor. If it is not possible to find one, we look for stem cells in the public banks of stem cells. Worldwide, there are about 500,000 transplants from cord available. Moreover, if a suitable donor cannot be found among siblings or volunteers, we can get the transplant from the mother or father of the child who are half-compatible with him or her because the child inherits half of the antibodies from one parent and half from the other. These transplantations are more difficult and risky but today we can succeed in 50% of them. I.e. today, every patient can undergo transplantation and regardless of the percentage of success, no one is left without treatment.

Do you cooperate with neighbouring countries for the treatment of patients?

We have admitted for treatment many children of Albanian origin, most of whom live with their families in Greece. However, we have had cases of children sent from Albania too. We have made transplantations in many children from Serbia.

I do not know if we have made transplantations in children from Bulgaria and the Former Yugoslav Republic of Macedonia. Probably we have, in Papanikolaou hospital in Thessaloniki, which is geographically closer to these two countries.

In every case, we are able to meet the needs of other countries. A few years ago, we had a budget for free transplants of patients from abroad. In today's economic situation, this is not possible, but I think that the issue could be regulated by an agreement between the Ministries of Health and we would be able to admit for treatment children from other Balkan countries as we used to in the past.

GRReporter report on the opening of the hospital is available below.