Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Improved diagnostic test benefits children with acute myeloid leukemia

11.09.2012
St. Jude Children’s Research Hospital study identifies the best test for determining treatment response in young leukemia patients, which could help guide therapy toward higher cure rate

Early treatment response is a powerful predictor of long-term outcome for young patients with acute myeloid leukemia (AML). The information can help physicians decide whether a more intensive approach is needed. Research led by St. Jude Children’s Research Hospital investigators has identified the best test for measuring that response and guiding therapy.

The method uses a laboratory technique called flow cytometry, which makes it possible to identify a single cancer cell in 1,000 normal cells that remain in patient bone marrow after the initial intensive weeks of chemotherapy. St. Jude investigators were instrumental in developing the test for identifying very low levels of cancer called minimal residual disease.

An analysis published in the September 10 online edition of the Journal of Clinical Oncology showed that checking for minimal residual disease by flow cytometry was better than two other widely used methods for predicting patient survival. The results help identify who might benefit from more intensive therapy, including bone marrow transplantation.

“These results will help establish flow cytometry testing for minimal residual disease as a routine tool for guiding therapy of acute myeloid leukemia and identifying patients early who are at risk of treatment failure,” said Hiroto Inaba, M.D., Ph.D., an associate member of the Department of Oncology at St. Jude. He is the study’s first and corresponding author.

Flow cytometry uses a laser to help distinguish cancer cells from normal cells based on different cell surface markers and other molecules. Dario Campana, M.D., Ph.D., led the successful St. Jude effort to develop the test about 15 years ago. Campana, now at the National University of Singapore, is the paper’s senior author.

Such testing is widely used to guide treatment of the most common childhood cancer, acute lymphoblastic leukemia (ALL). AML targets different white blood cells than ALL does. AML also affects fewer children and adolescents, about 500 annually in the U.S., and has a lower survival rate. Although 94 percent of St. Jude ALL patients can now look forward to becoming long-term survivors, the figure is 71 percent for young AML patients.

AML treatment response is evaluated on day 22 of therapy as well as at the end of each treatment phase and serves as a powerful predictor of patient survival. The results are used to guide ongoing therapy and identify patients who are candidates for more intense treatment.

For decades, physicians have relied on the microscope to evaluate patient response to therapy. Patients are considered to be in remission if a bone marrow examination finds cancer cells account for fewer than five in 100 cells. Flow cytometry and another laboratory technique called polymerase chain reaction (PCR) were also developed to help gauge treatment response. PCR is used to monitor genes created when chromosomes break and swap pieces. The genes are found in about half of all pediatric AML cases.

This study is the most comprehensive effort yet comparing the power of the three approaches to predict the AML treatment outcome. The work involved 203 AML patients enrolled in a clinical trial called AML02. St. Jude led the multi-institution study of young AML patients whose disease was diagnosed between 2002 and 2008. The project marked the first time minimal residual disease was used to guide therapy. During the study researchers examined 1,514 patient bone marrow samples by flow cytometry. Of those samples, 1,382 also had information regarding microscopic evaluation and 508 of PCR testing.

The analysis showed that minimal residual disease measured by flow cytometry was an independent predictor of patient outcome. Finding even one leukemia cell in 1,000 normal cells in bone marrow after the first or second round of therapy was associated with a worse prognosis and a greater risk of relapse or treatment failure.

Researchers concluded microscopic examination had limited value for gauging treatment response. Problems ranged from an inability to distinguish between cells destined to become leukemia cells and normal blood cells to classifying about 10 percent of patients as being in remission when flow cytometry identified leukemia cells in the same bone marrow.

Investigators also concluded that flow cytometry rendered PCR testing unnecessary for most AML patients. The analysis found PCR testing generally overestimated the presence of leukemia cells. In this study, PCR identified 197 of 311 patient samples as containing leukemia cells. Flow cytometry of the same samples showed just 19 actually harbored detectible minimal residual disease. Researchers did find PCR testing valuable in predicting outcome and guiding therapy for a subgroup of AML patients with mixed lineage leukemia (MLL) gene changes.

The other authors are Elaine Coustan-Smith, National University of Singapore; Xueyuan Cao, Stanley Pounds, Sheila Shurtleff, Susana Raimondi, Jeffrey Jacobsen, Raul Ribeiro, Wing Leung, James Downing, Ching-Hon Pui and Jeffrey Rubnitz, all of St. Jude; Kathleen Wang and Mihaela Onciu, both formerly of St. Jude; Gary Dahl, Lucile Packard Children’s Hospital and Stanford Cancer Center, Palo Alto, CA.; W. Paul Bowman, Cook Children’s Medical Center, Fort Worth; Jeffrey Taub, Children’s Hospital of Michigan, Detroit; and Barbara Degar, Dana-Farber Cancer Institute, Boston.

The research was supported in part by grants (CA115422, CA023944 and CA021765) from the National Cancer Institute at the National Institutes of Health and ALSAC.

St. Jude Children’s Research Hospital
Since opening 50 years ago, St. Jude Children’s Research Hospital has played a pivotal role in pushing overall U.S. pediatric cancer survival rates from 20 to 80 percent. Founded by the late entertainer Danny Thomas, St. Jude is the first and only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children. St. Jude is also a leader in research and treatment of life-threatening blood disorders and infectious diseases in children. No family ever pays St. Jude for the care their child receives. To learn more, visit www.stjude.org. Follow us on Twitter @StJudeResearch.

St. Jude Media Relations Contacts

Summer Freeman
(desk) 901-595-3061
(cell) 901-297-9861
summer.freeman@stjude.org
Carrie Strehlau
(desk) 901-595-2295
(cell) 901-297-9875
carrie.strehlau@stjude.org

Carrie Strehlau | EurekAlert!
Further information:
http://www.stjude.org

More articles from Health and Medicine:

nachricht GLUT5 fluorescent probe fingerprints cancer cells
20.04.2018 | Michigan Technological University

nachricht Scientists re-create brain neurons to study obesity and personalize treatment
20.04.2018 | Cedars-Sinai Medical Center

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: BAM@Hannover Messe: innovative 3D printing method for space flight

At the Hannover Messe 2018, the Bundesanstalt für Materialforschung und-prüfung (BAM) will show how, in the future, astronauts could produce their own tools or spare parts in zero gravity using 3D printing. This will reduce, weight and transport costs for space missions. Visitors can experience the innovative additive manufacturing process live at the fair.

Powder-based additive manufacturing in zero gravity is the name of the project in which a component is produced by applying metallic powder layers and then...

Im Focus: Molecules Brilliantly Illuminated

Physicists at the Laboratory for Attosecond Physics, which is jointly run by Ludwig-Maximilians-Universität and the Max Planck Institute of Quantum Optics, have developed a high-power laser system that generates ultrashort pulses of light covering a large share of the mid-infrared spectrum. The researchers envisage a wide range of applications for the technology – in the early diagnosis of cancer, for instance.

Molecules are the building blocks of life. Like all other organisms, we are made of them. They control our biorhythm, and they can also reflect our state of...

Im Focus: Spider silk key to new bone-fixing composite

University of Connecticut researchers have created a biodegradable composite made of silk fibers that can be used to repair broken load-bearing bones without the complications sometimes presented by other materials.

Repairing major load-bearing bones such as those in the leg can be a long and uncomfortable process.

Im Focus: Writing and deleting magnets with lasers

Study published in the journal ACS Applied Materials & Interfaces is the outcome of an international effort that included teams from Dresden and Berlin in Germany, and the US.

Scientists at the Helmholtz-Zentrum Dresden-Rossendorf (HZDR) together with colleagues from the Helmholtz-Zentrum Berlin (HZB) and the University of Virginia...

Im Focus: Gamma-ray flashes from plasma filaments

Novel highly efficient and brilliant gamma-ray source: Based on model calculations, physicists of the Max PIanck Institute for Nuclear Physics in Heidelberg propose a novel method for an efficient high-brilliance gamma-ray source. A giant collimated gamma-ray pulse is generated from the interaction of a dense ultra-relativistic electron beam with a thin solid conductor. Energetic gamma-rays are copiously produced as the electron beam splits into filaments while propagating across the conductor. The resulting gamma-ray energy and flux enable novel experiments in nuclear and fundamental physics.

The typical wavelength of light interacting with an object of the microcosm scales with the size of this object. For atoms, this ranges from visible light to...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Invitation to the upcoming "Current Topics in Bioinformatics: Big Data in Genomics and Medicine"

13.04.2018 | Event News

Unique scope of UV LED technologies and applications presented in Berlin: ICULTA-2018

12.04.2018 | Event News

IWOLIA: A conference bringing together German Industrie 4.0 and French Industrie du Futur

09.04.2018 | Event News

 
Latest News

Quantum Technology for Advanced Imaging – QUILT

24.04.2018 | Information Technology

AWI researchers measure a record concentration of microplastic in arctic sea ice

24.04.2018 | Earth Sciences

Complete skin regeneration system of fish unraveled

24.04.2018 | Life Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>