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    St. Jude develops more affordable ALL follow-up test

    Simple new test is inexpensive enough to use routinely in institutes with limited resources; it guides fine-tuning of follow-up therapy to save more children from harsh chemo, fatal infections.

    St. Jude investigators have developed a relatively simple and inexpensive test that identifies children with acute lymphoblastic leukemia (ALL) who have responded well enough to their first round of chemotherapy that they might be successfully treated with a much less aggressive follow-up treatment.

    The new test could give hospitals with limited resources an affordable way to improve the outcomes of ALL treatments for many children by reducing chemotherapy side effects.

    A report on this new technique appears in the March pre-publication online issue of Blood.

    The test measures minimal residual disease (MRD)—the small number of leukemic cells that survive after remission induction therapy. This measurement helps clinicians identify patients whose disease is highly responsive to chemotherapy and those who might be cured with milder and less toxic treatment.

    The high cost and complexity of the more sophisticated MRD tests have been major obstacles to their use in countries with limited resources, according to the paper’s senior author, Dario Campana, M.D., Ph.D., of Hematology-Oncology and Pathology at St. Jude. “That limited the number of children who could benefit from MRD assays,” Campana said. The result of the new test closely agreed with those from the more expensive and complex tests, said the paper’s first author, Elaine Coustan-Smith, also of Hematology-Oncology and Pathology at St. Jude.

    St. Jude is now implementing this new test at a partner institution in Brazil, according to the paper’s co-author, Raul Ribeiro, M.D., International Outreach Program director at St Jude. The pilot project in Recife, Brazil, aims to identify children who have MRD levels low enough that they can be treated with therapy that is less intense than the standard treatment. Previously, 10 percent of the children in Recife receiving standard therapy suffered fatal infections caused by the aggressive treatment, Ribeiro noted. Therefore, in addition to improving supportive care for patients, investigators in Recife want to reduce the intensity of treatment for a selected group of patients.

    The other St. Jude authors of the paper include Ching-Hon Pui, MD, and Patricia Stow, Hematology-Oncology; Yinmei Zhou, Biostatistics; and Gaston Rivera, International Outreach.

    Last update: April 2006