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    Jeffrey E. Rubnitz, MD, PhD

    Better outcomes for pediatric AML

    A new strategy for treating childhood acute myeloid leukemia (AML) based on the individual patient’s risk of failure, and guided by the results of a highly sensitive technique for identifying leukemic cells, yielded one-year survival rates of almost 90 percent, according to investigators at St. Jude Children’s Research Hospital and a national consortium of research institutes.

    The ongoing clinical trial, called AML02, also found that almost 77 percent of survivors were free of leukemia one year from diagnosis. Among the 112 patients enrolled since October 2002, four died from infections that occurred during or after completion of chemotherapy.

    AML02 was the first to use minimal residual disease (MRD) measurements in a study of AML treatments to make accurate assessments of treatment response for each child, and to adjust treatment accordingly. Using a flow cytometry, researchers identified abnormal combinations of proteins that appear only on the surface of leukemic cells. This allowed the investigators to quickly and accurately determine the percentage of such cells in bone marrow samples.

    Doctors used MRD measurements made after the initial part of therapy to determine if the treatment was eliminating enough leukemic cells to ensure a high probability of success. Based on that information, the doctors modified the intensity of treatment to avoid unnecessary therapy or intensify therapy. Until now, researchers had to rely on the less-accurate technique of microscopic examination to determine which cells in a child’s blood sample were leukemic.

    A report on these findings was presented at the 47th annual conference of the American Society of Hematology December 12 in Atlanta, Georgia, by Jeffrey Rubnitz, M.D., Ph.D., an associate member of the St. Jude Department of Hematology-Oncology. AML02 is the first multi-institutional study of a specific St. Jude investigational protocol, according to Rubnitz.

    “The future will show if there is a long-term benefit to our being able to identify slow responders and the effect of intensifying therapy for such patients,” he said. “But the results of this study are very encouraging.”

    The other researchers involved in this study include Bassem Razzouk, Stanley Pounds, Raul Ribeiro, Ching-Hon Pui, Elaine Coustan-Smith, Dario Campana, and Shelly Lensing (St. Jude); Paul Bowman (Cook Children’s Medical Center, Forth Worth, TX); Gary Dahl and Norman Lacayo (Stanford University Medical Center, Palo Alto, CA); Jeffrey Taub and Yaddanapudi Ravindranath (Children’s Hospital of Michigan-Detroit); Soheil Meshinchi (Children’s Hospital, Seattle, WA); and Gladstone Airewele (Texas Children’s Cancer Center, Houston, TX).

     

    Last update: January 2006