Childhood acute lymphoblastic leukemia – a modern cancer success story


Feature 2

Advances in diagnosis and treatment mean more children are living longer with cancer than ever before, with about 270,000 childhood cancer survivors alive today nationwide. Despite these advances, cancer remains the leading cause of death due to disease among U.S. children over one year of age.

September is National Childhood Cancer Awareness Month, but for researchers at St. Jude Children’s Research Hospital, it is a year round mission to research new ways to help more children live long, active lives while also working to better understand the challenges childhood cancer survivors face.

“Our goal is to push the cure rate for all childhood cancers to 90 percent in the next decade. Rapid advances in science and technology, especially at the genetic level, are going to make that possible,” said Dr. William E. Evans, St. Jude director and chief executive officer. St. Jude is the nation’s only federally funded cancer center focused solely on childhood cancer.

In June, St. Jude investigators reported in the New England Journal of Medicine they had achieved that milestone for patients with ALL, a cancer of the white blood cells. This year ALL will be discovered in about 3,000 U.S. children, making it the most common childhood cancer. More tailored chemotherapy linked to the genetics of the patient and the patient’s tumor as well as more sophisticated monitoring of the patient’s response to treatment resulted in a projected 10-year cure rate of 90 percent.

Investigators reached the goal without using cranial irradiation in even high-risk cases. In 1965, radiation therapy helped push ALL cure rates to 50 percent. But because of serious long-term side effects, researchers have been working for years to reduce its use.

Childhood ALL is one of the success stories of modern oncology. When St. Jude opened in 1962, just 4 percent of young patients survived. “It was considered quite radical to talk cure at that time,” Dr. Donald Pinkel said. He was the hospital’s first director and chief executive officer. He pioneered an approach to ALL treatment that involved combining multiple drugs with radiation. The strategy remains the basis for care in the 21st century.

“It became a model for curing systemic disseminated cancer,” Evans said. “It advanced the whole field of oncology.”

Evans said research is now focused on developing therapies that more effectively target cancer cells. “The secret is going to be in the genome of these tumors,” he explained, referring to the inherited genetic instructions found inside nearly every cell.

“As we sequence more and more cancer genomes, finding the mutations that cause a white blood cell to become leukemia will be the key to finding targets for these new therapies,” he said.

This year cancer will be diagnosed in more than 10,000 children and adolescents age 14 and younger.  

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September 2009

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