Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Improved acute lymphoblastic leukemia treatment offers hope for eliminating irradiation

03.11.2004


St. Jude clinical trial XIIIB was based on stringent risk classification, early intensification of chemotherapy and addition of dexamethasone to improve outcome and increase quality of life



Improved risk classification for patients with acute lymphoblastic leukemia (ALL), coupled with more intensive intrathecal chemotherapy for high risk patients and the use of a drug called dexamethasone, could one day permit physicians to omit irradiation as a part of routine treatment. These findings emerged from a clinical trial conducted by investigators at St. Jude Children’s Research Hospital. For intrathecal chemotherapy the drugs are injected into the cerebrospinal fluid-filled spaces between the thin membranes covering the spinal cord.

The researchers base their conclusion on results of a study of ALL treatment at St. Jude called Total Therapy Study XIIIB, which are reported in the Nov. 1 issue of the journal Blood. The overall five-year event-free survival rate of the children in Study XIIIB was just above 80 percent, and the overall survival rate was about 86 percent, according to the researchers. Event-free survival means that patients do not experience a recurrence of symptoms or other complications related to the disease or its treatment.


The researchers substituted dexamethasone for the routinely used drug prednisone to achieve greater antileukemic effects in both the central nervous system (brain and spinal cord) and the blood stream. The investigators also used more precise criteria to identify those children who should get more intensive intrathecal and intravenous therapy because they were at high risk for treatment failure.

Success of the modified chemotherapy treatment of XIIIB is significant because it established the importance of intensifying intrathecal chemotherapy early in treatment, and also set the stage for the current St. Jude clinical trial that omits the use of cranial irradiation in all patients, according to Ching-Hon Pui, M.D., director of the St. Jude Leukemia/Lymphoma Division, and American Cancer Society F.M. Kirby Clinical Research Professor. Pui is the first author of the Blood article. "The ability to omit cranial irradiation while still achieving a high cure rate for ALL would be an important breakthrough," Pui said. "Radiation in children often leads to long-term side effects, such as second cancer and disruption of intellectual development, academic performance and growth. We’d like to spare our children those problems and give them a better quality of life as adults."

Currently, clinicians commonly use cranial radiation to treat patients at high risk of developing a relapse of ALL in the central nervous system. The new, stricter criteria allowed the St. Jude clinicians to limit cranial irradiation to 12 percent of patients in Study XIIIB, compared to 22 percent of those in a previous clinical trial, Total Therapy Study XIIIA.

Total Therapy Study XIIIB included 247 patients 18 years old and younger who underwent treatment for ALL and were followed for up to nine years to determine the treatment effectiveness and to monitor therapy side effects. A total of 117 patients were classified as having low-risk ALL, while 130 were classified as high risk.

Lower-risk patients were identified according to a variety of specific characteristics. For example, those who did not have a form of leukemia called T-cell ALL, or a certain genetic mutation in their leukemic cells called the Philadelphia chromosome were considered lower risk.

The classification system used in Study XIIIB, a revision of the one used in Study XIIIA, improved investigators’ ability to identify patients who should get more intensive post-remission treatment to increase the chance of event-free survival. Post-remission therapy is given after the initial treatment to kill leukemic cells remaining after the initial, or induction, therapy. High-risk patients received more intensive chemotherapy than did low-risk patients. In addition, while all patients received initial intrathecal chemotherapy, high-risk patients received more doses over time than did low-risk patients. Patients considered at high risk for relapse were those who had T-cell ALL and especially high white blood cell counts, or patients with evidence of leukemia in the central nervous systems.

The overall event-free-survival rate of low-risk patients in Study XIIIB was about 89 percent, while the rate for high-risk patients was about 74 percent. Only 1 percent of patients experienced a relapse where leukemic cells appeared in their central nervous systems. "Our ultimate goal is to cure all patients with ALL," said William E. Evans, Pharm.D., St. Jude hospital director and a senior author of the paper. "To do this, we will have to continue to improve our ability to target therapy more effectively in patients with genetic abnormalities that identify them as being at high risk for treatment failure. For example, we are already testing a new treatment for high-risk patients with ALL carrying the Philadelphia chromosome."

Bonnie Cameron | EurekAlert!
Further information:
http://www.stjude.org

More articles from Health and Medicine:

nachricht New High-Performance Center Translational Medical Engineering
26.04.2017 | Fraunhofer ITEM

nachricht A promising target for kidney fibrosis
21.04.2017 | Brigham and Women's Hospital

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: Making lightweight construction suitable for series production

More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.

Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...

Im Focus: Wonder material? Novel nanotube structure strengthens thin films for flexible electronics

Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.

"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...

Im Focus: Deep inside Galaxy M87

The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.

Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...

Im Focus: A Quantum Low Pass for Photons

Physicists in Garching observe novel quantum effect that limits the number of emitted photons.

The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...

Im Focus: Microprocessors based on a layer of just three atoms

Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.

Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Expert meeting “Health Business Connect” will connect international medical technology companies

20.04.2017 | Event News

Wenn der Computer das Gehirn austrickst

18.04.2017 | Event News

7th International Conference on Crystalline Silicon Photovoltaics in Freiburg on April 3-5, 2017

03.04.2017 | Event News

 
Latest News

Scientist invents way to trigger artificial photosynthesis to clean air

26.04.2017 | Materials Sciences

Ammonium nitrogen input increases the synthesis of anticarcinogenic compounds in broccoli

26.04.2017 | Agricultural and Forestry Science

SwRI-led team discovers lull in Mars' giant impact history

26.04.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>