Understanding success in treating pediatric acute lymphoblastic leukemia combined with molecular science could help clinicians treat adolescents and adults with the disease
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MEMPHIS, Tenn., March 20 /PRNewswire-USNewswire/ -- The dramatic increase that has occurred in the cure rate for children with acute lymphoblastic leukemia (ALL) will be difficult to replicate in older patients without considerable additional research, according to an article by St. Jude Children's Research Hospital authors that appears in the March 22 issue of "The Lancet."
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In order to raise the survival rate of adolescents and adults with ALL, researchers will need a more thorough understanding of the biology of this form of leukemia, including the role that genes play in therapies, according to Ching-Hon Pui, M.D., St. Jude Department of Oncology chair. Currently, adolescents treated for ALL do not fare as well as children; and among adults with ALL, only 30 to 40 percent are cured.
Cure rates for children with ALL -- defined as 10 years of cancer-free survival -- were about 4 percent when St. Jude opened its doors in 1962; but by the end of that decade researchers showed for the first time that treatments using a combination of existing cancer drugs significantly improved ALL survival. Subsequent research at St. Jude contributed in large part to the current high cure rate achieved in children with ALL over the past four decades
Today, pediatric ALL patients at St. Jude have a cure rate approaching 90 percent, Pui said. "We already have 94 percent surviving at 5 years."
In "The Lancet" article, Pui and his colleagues noted that researchers are investigating two areas of molecular science that hold promise for improving the survival and quality of life of ALL patients, including adolescents and adults.
One is gene-expression profiling, which measures the amount of messenger RNA made by different genes in different cell types; and the other is pharmacogenetics. RNA is the decoded form of genes and is a signal that those genes have been active. Pharmacogenetics is the study of how genes influence a person's responses to drugs.
Some ALL specialists envision a time when oncologists use leukemic cell genetics and host pharmacogenetics to match specific treatments to individual patients.
"We need to know the leukemic cell genetics that affect drug sensitivity or resistance and what role pharmacogenetics plays in treatment to improve efficacy and decrease toxicity," Pui said. "That way, we don't over treat low-risk patients or under treat high-risk patients."
Other authors of this paper include Les Robison (St. Jude) and A. Thomas Look (Dana-Farber Cancer Institute and Harvard Medical School, Boston).
This work was supported in part by grants from the National Institutes of Health and ALSAC.
St. Jude Children's Research Hospital
St. Jude Children's Research Hospital is internationally recognized for its pioneering work in finding cures and saving children with cancer and other catastrophic diseases. Founded by late entertainer Danny Thomas and based in Memphis, Tenn., St. Jude freely shares its discoveries with scientific and medical communities around the world. No family ever pays for treatments not covered by insurance, and families without insurance are never asked to pay. St. Jude is financially supported by ALSAC, its fundraising organization. For more information, please visit www.stjude.org.
SOURCE St. Jude Children's Research Hospital
