Measuring the concentration of leukemia cells in patient bone marrow during the first 46 days of chemotherapy should help boost survival of young leukemia patients by better matching patients with the right intensity of chemotherapy. St. Jude Children's Research Hospital investigators led the research, which appears in the March 20 edition of the journal Lancet Oncology.
The findings stem from a study of 498 children and adolescents with acute lymphoblastic leukemia (ALL) enrolled in a St. Jude-led protocol between 2000 and 2007. The clinical trial was the first to use measurement of residual leukemia cells – or minimal residual disease (MRD) – in bone marrow to help guide therapy. St. Jude pioneered MRD measurement as a tool to guide leukemia treatment.
"This analysis shows that MRD-directed therapy clearly contributed to the unprecedented high rates of long-term survival that patients in this study achieved," said first and corresponding author Ching-Hon Pui, M.D., chair of the St.Jude Department of Oncology. Overall, 93.5 percent of patients were alive five years after their cancer was diagnosed. "MRD proved to be a powerful way to identify high-risk patients who needed more intensive therapy and helped us avoid over-treatment of low-risk patients by reducing their exposure to chemotherapy," Pui said.
Researchers hope the findings will expand use of MRD measurements to guide leukemia treatment in children and adults.
The technique might also help identify patients who could be cured with less intensive chemotherapy, Pui said. Overall long-term survival was 97.9 percent or better for 244 patients in this study classified as low risk based on a variety of factors including their age at diagnosis and MRD of less than 1 percent on day 19 of treatment. "Given the excellent outcome, it will be important to determine if treatment can be further reduced in this subgroup of patients," Pui said.
In countries with limited resources, Pui said the findings suggest that results of MRD on day 19 can be used to reduce treatment-related deaths by identifying patients who will likely be cured with low-intensity chemotherapy. "This study demonstrates these patients have an extremely low risk of relapse," he said.
The study showed that measuring MRD just twice during remission induction therapy – at day 19 and day 46 – rather than multiple times during the more than two years of treatment was sufficient to guide treatment of most pediatric ALL patients. That will help save money and protect patients from the discomfort and risks associated with bone marrow aspiration for MRD testing. MRD measurements should continue, however, to guide treatment of patients with detectable MRD on day 46 of treatment. That is a level of 0.01 percent or more, which translates into one leukemia cell in 10,000 normal cells.
MRD was not a perfect predictor of relapse risk. Cancer returned in 26 of the 430 patients with undetectable MRD when treatment ended after 120 weeks. Researchers are working to develop even more sensitive methods for tracking treatment response in order to identify those at risk for having their cancer return.
Overall, researchers showed that regardless of other risk factors, including age at diagnosis or the initial white blood cell count, patients with an MRD level of 1 percent or more on day 19 of therapy were far less likely than other young leukemia patients to be alive and cancer-free 10 years later. Having detectable leukemia cells on day 46 of treatment was also associated with lower survival.
MRD levels on days 19 and 46 led to the reclassification of 50 patients from low risk to a higher risk leukemia that warranted more intensive therapy. Researchers credited the change with boosting survival.
The other authors are Deqing Pei, Sima Jeha, Cheng Cheng, John Sandlund, Raul Ribeiro, Jeffrey Rubnitz, Hiroto Inaba, Deepa Bhojwani, Tanja Gruber, Wing Leung, James R. Downing, William Evans and Mary Relling, all of St. Jude; Elaine Coustan-Smith and Dario Campana, both of the National University of Singapore; and W. Paul Bowman, of the University of North Texas Health Sciences Center, Fort Worth, Texas.
Explore further: Good news for young patients with a leukemia subtype associated with a poor prognosis
Medical Xpress on facebook
Related Stories
Good news for young patients with a leukemia subtype associated with a poor prognosis
Sep 24, 2014
St. Jude Children's Research Hospital investigators found that adjusting treatment based on early response to chemotherapy made a life-saving difference to young patients with an acute lymphoblastic leukemia (ALL) subtype ...
Drug offers promising approach to improve outcome for children with high-risk leukemia
Nov 15, 2013
Combining the drug gemtuzumab ozogamicin (GO) with conventional chemotherapy may improve the outcome of bone marrow transplantation for some children battling high-risk acute myeloid leukemia (AML), according to a study led ...
Obese youths with leukemia more likely to have persistent disease
Oct 27, 2014
Obese youths with acute lymphoblastic leukemia (ALL) are known to have worse outcomes than their lean counterparts. To find out why, investigators at Children's Hospital Los Angeles studied patients who were ...
Team zeroes in on better way to predict prognosis in pediatric leukemia patients
Apr 09, 2010
Researchers from the Children's Cancer Hospital at The University of Texas M. D. Anderson Cancer Center may have found a way to more accurately predict treatment outcomes in young leukemia patients using information ...
Smarter use of existing treatment helps dramatically boost survival of young AML patients
May 10, 2010
More individualized therapy and better supportive care helped push the survival for children with acute myeloid leukemia (AML) to 71 percent three years after diagnosis, according to new research led by St. Jude Children's ...
Recommended for you
How our DNA may prevent bowel cancer
17 minutes ago
A new study published in the prestigious Journal of the American Medical Association (JAMA) suggests the link between aspirin and colon cancer prevention may depend on a person's individual genetics. ...
Stinging nettle chemical improves cancer drug
1 hour ago
A cancer drug could be made 50 times more effective by a chemical found in stinging nettles and ants, new research finds.
Cancer therapy 'tumor sanctuaries' and the breeding ground of resistance
17 hours ago
Tumors acquiring resistance is one of the major barriers to successful cancer therapy. Feng Fu, Sebastian Bonhoeffer (ETH Zurich) and their collaborator Martin Nowak (Harvard) use mathematical models to characterize ...
Kidney cancer detected early with urine test
20 hours ago
If kidney cancer is diagnosed early—before it spreads—80 percent of patients survive. However, finding it early has been among the disease's greatest challenges.
Racial, ethnic differences in picking surgeons, hospitals for breast cancer care
20 hours ago
Black and Hispanic women with breast cancer were less likely to pick their surgeon and the hospital for treatment based on reputation compared with white women, suggesting minority patients may rely more on physician referrals ...
World-first cancer drugs could work in larger group of patients
22 hours ago
A pioneering class of drugs that target cancers with mutations in the BRCA breast cancer genes could also work against tumours with another type of genetic fault, a new study suggests.
User comments
Please sign in to add a comment. Registration is free, and takes less than a minute. Read more
Click here to reset your password.
Sign in to get notified via email when new comments are made.
© Medical Xpress 2011-2014, Science X network
Measuring the concentration of leukemia cells in patient bone marrow during the first 46 days of chemotherapy should help boost survival of young leukemia patients by better matching patients with the right intensity of chemotherapy. St. Jude Children's Research Hospital investigators led the research, which appears in the March 20 edition of the journal Lancet Oncology.
The findings stem from a study of 498 children and adolescents with acute lymphoblastic leukemia (ALL) enrolled in a St. Jude-led protocol between 2000 and 2007. The clinical trial was the first to use measurement of residual leukemia cells – or minimal residual disease (MRD) – in bone marrow to help guide therapy. St. Jude pioneered MRD measurement as a tool to guide leukemia treatment.
"This analysis shows that MRD-directed therapy clearly contributed to the unprecedented high rates of long-term survival that patients in this study achieved," said first and corresponding author Ching-Hon Pui, M.D., chair of the St.Jude Department of Oncology. Overall, 93.5 percent of patients were alive five years after their cancer was diagnosed. "MRD proved to be a powerful way to identify high-risk patients who needed more intensive therapy and helped us avoid over-treatment of low-risk patients by reducing their exposure to chemotherapy," Pui said.
Researchers hope the findings will expand use of MRD measurements to guide leukemia treatment in children and adults.
The technique might also help identify patients who could be cured with less intensive chemotherapy, Pui said. Overall long-term survival was 97.9 percent or better for 244 patients in this study classified as low risk based on a variety of factors including their age at diagnosis and MRD of less than 1 percent on day 19 of treatment. "Given the excellent outcome, it will be important to determine if treatment can be further reduced in this subgroup of patients," Pui said.
In countries with limited resources, Pui said the findings suggest that results of MRD on day 19 can be used to reduce treatment-related deaths by identifying patients who will likely be cured with low-intensity chemotherapy. "This study demonstrates these patients have an extremely low risk of relapse," he said.
The study showed that measuring MRD just twice during remission induction therapy – at day 19 and day 46 – rather than multiple times during the more than two years of treatment was sufficient to guide treatment of most pediatric ALL patients. That will help save money and protect patients from the discomfort and risks associated with bone marrow aspiration for MRD testing. MRD measurements should continue, however, to guide treatment of patients with detectable MRD on day 46 of treatment. That is a level of 0.01 percent or more, which translates into one leukemia cell in 10,000 normal cells.
MRD was not a perfect predictor of relapse risk. Cancer returned in 26 of the 430 patients with undetectable MRD when treatment ended after 120 weeks. Researchers are working to develop even more sensitive methods for tracking treatment response in order to identify those at risk for having their cancer return.
Overall, researchers showed that regardless of other risk factors, including age at diagnosis or the initial white blood cell count, patients with an MRD level of 1 percent or more on day 19 of therapy were far less likely than other young leukemia patients to be alive and cancer-free 10 years later. Having detectable leukemia cells on day 46 of treatment was also associated with lower survival.
MRD levels on days 19 and 46 led to the reclassification of 50 patients from low risk to a higher risk leukemia that warranted more intensive therapy. Researchers credited the change with boosting survival.
The other authors are Deqing Pei, Sima Jeha, Cheng Cheng, John Sandlund, Raul Ribeiro, Jeffrey Rubnitz, Hiroto Inaba, Deepa Bhojwani, Tanja Gruber, Wing Leung, James R. Downing, William Evans and Mary Relling, all of St. Jude; Elaine Coustan-Smith and Dario Campana, both of the National University of Singapore; and W. Paul Bowman, of the University of North Texas Health Sciences Center, Fort Worth, Texas.
Explore further: Good news for young patients with a leukemia subtype associated with a poor prognosis
Medical Xpress on facebook
Related Stories
Good news for young patients with a leukemia subtype associated with a poor prognosis
Sep 24, 2014
St. Jude Children's Research Hospital investigators found that adjusting treatment based on early response to chemotherapy made a life-saving difference to young patients with an acute lymphoblastic leukemia (ALL) subtype ...
Drug offers promising approach to improve outcome for children with high-risk leukemia
Nov 15, 2013
Combining the drug gemtuzumab ozogamicin (GO) with conventional chemotherapy may improve the outcome of bone marrow transplantation for some children battling high-risk acute myeloid leukemia (AML), according to a study led ...
Obese youths with leukemia more likely to have persistent disease
Oct 27, 2014
Obese youths with acute lymphoblastic leukemia (ALL) are known to have worse outcomes than their lean counterparts. To find out why, investigators at Children's Hospital Los Angeles studied patients who were ...
Team zeroes in on better way to predict prognosis in pediatric leukemia patients
Apr 09, 2010
Researchers from the Children's Cancer Hospital at The University of Texas M. D. Anderson Cancer Center may have found a way to more accurately predict treatment outcomes in young leukemia patients using information ...
Smarter use of existing treatment helps dramatically boost survival of young AML patients
May 10, 2010
More individualized therapy and better supportive care helped push the survival for children with acute myeloid leukemia (AML) to 71 percent three years after diagnosis, according to new research led by St. Jude Children's ...
Recommended for you
How our DNA may prevent bowel cancer
17 minutes ago
A new study published in the prestigious Journal of the American Medical Association (JAMA) suggests the link between aspirin and colon cancer prevention may depend on a person's individual genetics. ...
Stinging nettle chemical improves cancer drug
1 hour ago
A cancer drug could be made 50 times more effective by a chemical found in stinging nettles and ants, new research finds.
Cancer therapy 'tumor sanctuaries' and the breeding ground of resistance
17 hours ago
Tumors acquiring resistance is one of the major barriers to successful cancer therapy. Feng Fu, Sebastian Bonhoeffer (ETH Zurich) and their collaborator Martin Nowak (Harvard) use mathematical models to characterize ...
Kidney cancer detected early with urine test
20 hours ago
If kidney cancer is diagnosed early—before it spreads—80 percent of patients survive. However, finding it early has been among the disease's greatest challenges.
Racial, ethnic differences in picking surgeons, hospitals for breast cancer care
20 hours ago
Black and Hispanic women with breast cancer were less likely to pick their surgeon and the hospital for treatment based on reputation compared with white women, suggesting minority patients may rely more on physician referrals ...
World-first cancer drugs could work in larger group of patients
22 hours ago
A pioneering class of drugs that target cancers with mutations in the BRCA breast cancer genes could also work against tumours with another type of genetic fault, a new study suggests.
User comments
Please sign in to add a comment. Registration is free, and takes less than a minute. Read more
Click here
to reset your password.
Sign in to get notified via email when new comments are made.
© Medical Xpress 2011-2014, Science X network
0 comments:
Post a Comment