ENIn Germany, childhood blood cancer, most often acute leukaemia, is treated by a protocol lasting months, not by one operation or drug. For parents facing a fresh diagnosis and asking where to go, the outcome depends above all on the form of the disease, an accurate diagnosis and complete treatment by protocol, not on a hospital’s address alone.
Below: forms, diagnosis, protocol and residual disease, transplantation, hospital life for child and parent, and what to collect first. For adults, see blood cancer treatment in Germany.
The forms of blood cancer in children
In children, blood cancer mostly means acute leukaemia, the largest group in paediatric oncology in Germany, and lymphoma. According to the German Childhood Cancer Registry (Annual Report 2022), over 95% of childhood leukaemias are acute; chronic forms are rare. Acute lymphoblastic leukaemia (ALL) is the most frequent, at about 80%; acute myeloid leukaemia (AML), at 15–20%, takes about half a year of intensive chemotherapy. Lymphomas usually start in a lymph node; childhood non-Hodgkin lymphomas almost always grow fast.
“Blood cancer” is not one diagnosis: subtypes within each form, defined by surface proteins and cell genetics, decide the therapy and its length.
Symptoms are usually unspecific (tiredness, pallor, bruising, unexplained fever, leg pain) and also occur in harmless illnesses, but see a paediatrician promptly. Diagnosis comes from the bone marrow, not a blood count or a forum. The WHO notes that childhood cancer generally cannot be prevented or detected by screening.
How the diagnosis is made
Several tests in the first days make the diagnosis: a blood count with a smear shows the cells’ number and look; a bone marrow aspiration gives the diagnostic material; immunophenotyping tags cells with antibodies to show their lineage, B or T, and maturity; cytogenetic and molecular tests find chromosome and gene changes; a lumbar puncture checks the central nervous system.
Even with a diagnosis from home, the German department re-reads the material, and some samples go to the study groups’ reference laboratories: subtype and risk group set the doses and duration, so a mistake costs more than a few days of checking.
Minimal residual disease means leukaemia cells left after the first weeks of therapy, too few for a microscope; sensitive molecular tests track them during treatment. A poor response intensifies the protocol; high risk raises the question of a transplant.
Treatment is a protocol, not a prescription
Blood cancer treatment for children in Germany follows a protocol of phases over many months: induction, consolidation, intensification, maintenance. Protocols come from GPOH (Society for Paediatric Oncology and Haematology) study groups and international partners, and almost every child is treated within a trial or registry. Current ALL trials include the international ALLTogether1. So one university children’s hospital works by the same rules as another.
Therapy combines chemotherapy into a vein and the spinal fluid, steroids and, in some subtypes, targeted drugs. Maintenance lasts longest: tablets at home, usually with nursery or school, and regular checks at the day clinic.
Alongside come transfusions, infection prevention and treatment, nutrition, pain relief, psychological support for child and family, and the hospital school. These are not extras: the German medical societies’ guideline (AWMF) calls psychosocial care an integral part of treatment, and this support helps a child tolerate therapy.
Bone marrow transplantation and cell therapy
In newly diagnosed ALL a bone marrow transplant is rarely needed; it is considered for high-risk disease, a poor residual disease response or relapse. Siblings are tested first: each has a one-in-four chance of matching tissue type. Without a family match, an unrelated donor is sought through registries; failing that, a half-matched parent is sometimes an option.
Conditioning comes first: high-dose chemotherapy, sometimes with total body irradiation. The child then spends several weeks in isolation until the donor cells engraft. The main risk, graft-versus-host disease, is donor immune cells attacking skin, liver or gut; it can be severe, so transplants are done in specialised centres.
CAR-T cell therapy is used in specialised centres for relapse of certain leukaemias, on strict indications: in the EU, tisagenlecleucel (Kymriah) is authorised for patients up to and including 25 years of age with B-cell ALL that is refractory, relapsed after a transplant, or in second or later relapse. The treating hospital sets the indication, not an article. The German Cancer Research Center’s Krebsinformationsdienst explains childhood cancer, including leukaemia, in German.
Hospitals and doctors
Two partner departments serve as examples. The children’s hospital and outpatient clinic at the Dr. von Haunersches Kinderspital of LMU Munich is directed by Professor Christoph Klein, a paediatrician specialised in paediatric haematology and oncology.
At Klinikum Stuttgart, the paediatric oncology, haematology and immunology department at the Olgahospital children’s hospital is led by PD Dr Claudia Blattmann. Klinikum Stuttgart groups several city hospitals and is an academic teaching hospital of the University of Tübingen. These are examples, not a ranking: the match follows the disease and where a bed is free now.
Frequently asked questions
Can a parent stay in hospital with the child?
Yes. The AWMF guideline says an accompanying adult should be able to stay with the child at any time, whatever the age, and wards should have parents’ rooms. Where you sleep (the child’s room, a parents’ room or nearby) depends on the ward and phase.
Can treatment started at home be continued in Germany?
Yes, but the receiving hospital decides where to pick up. It needs the original diagnosis and subtype, the protocol, each phase with dates and doses, and the response, including residual disease. With a comparable protocol, treatment can continue; otherwise doctors plan the switch.
How long does treatment take?
For ALL, the protocol usually runs for about two years: about six months of intensive treatment, then maintenance outside hospital with regular checks. AML treatment is shorter. The treatment plan shows how much of this time the family will spend in Germany.
How AlenMed organises treatment
AlenMed sends the child’s records to specialist paediatric departments at partner hospitals: discharge letters, bone marrow report with immunophenotype and genetics, blood results, therapy given with dates and doses, age and weight. The reply brings a plan and an admission date.
AlenMed has 86 partner hospitals in 38 cities and 345 doctors; its office is in Munich. A coordinator handles visas for the child and accompanying parent, finds accommodation near the hospital for months rather than days, interprets at appointments and the consent conversation, and collects the discharge letter with the follow-up plan.
This material is for information only, not an offer; a doctor decides on treatment at a face-to-face examination.