One of the challenges in treating cancer is figuring out how intense the treatment should be for a patient.
A team led by Ching-Hon Pui, MD, Oncology chair at St. Jude Children’s Research Hospital, recently demonstrated that measuring the number of leukemia cells in patient bone marrow early in treatment can help determine how intense the chemotherapy needs to be for patients with acute lymphoblastic leukemia (ALL).
“This is the most powerful way to identify high-risk patients who need more intensive therapy. It also helps us avoid over-treating low-risk patients,” Pui explains.
The procedure evaluates a patient’s response to treatment. The test measures minimal residual disease (MRD)—the number of leukemia cells that remain during and after the first phase of treatment, which is called remission induction therapy. MRD testing is done on the 19th and 46th days of induction treatment when, Pui says, “we can identify patients who will have very, very good treatment outcomes without intensive therapy.”
Those patients can receive low-intensity therapy, which lowers the risks of treatment-related side effects.
Children with higher MRD results require more intensive therapy for cures. Thanks in part to this method, 94 percent of children with ALL survive their disease.
St. Jude is the first hospital to pioneer the use of MRD to help guide treatment.
Sweet remission
A St. Jude study about MRD published in the journal Lancet Oncology showed that MRD testing twice, instead of multiple times during the 2.5 years of treatment, was enough to guide therapy. Not only does that save money, but it also helps children avoid the discomfort and risk of repeated bone marrow aspirations.
The MRD test can detect even one leukemia cell among 10,000 normal cells. But that’s not good enough for Pui and his team.
They plan to further fine-tune the test, so that hospitals worldwide can use it to separate high-risk patients from those who can be cured with lower levels of treatment. Pui and his colleagues hope the use of MRD tests can also extend beyond children to adults.
“Research is needed to determine if even more sensitive methods of MRD measurement can improve our precision in predicting outcomes,” Pui says. “It is also important to develop simple methods that maintain or increase the reliability and can be readily extended to all laboratories and, hence, all patients.”
Reprinted from Promise, Summer 2015
More articles from this issue
-
Ewing Sarcoma: Changing Hues
A spectrum of discoveries in St. Jude labs and clinics offer promise for patients with Ewing sarcoma.
-
Ten Fingers Ten Toes
St. Jude scientists’ discoveries offer hope for some of the tiniest and most vulnerable patients—babies with a rare and aggressive form of leukemia.
-
Leaving the Nest
The St. Jude Endocrine Clinic helps families gain the confidence and knowledge they need to spread their wings.
-
Jaxon's Journey
After a minor accident prompted a medical evaluation that led to an early diagnosis of medulloblastoma, a 13-year-old boy expresses his story in poetry form.
-
Source Code
St. Jude scientists discover the genetic basis of the side effects that sometimes accompany cancer treatment.
-
Melanoma: Signs and Subtypes
For decades, the genetic basis of pediatric melanoma was a mystery. But St. Jude scientists recently discovered the molecular signatures of three pediatric melanoma subtypes.
-
Racing to Save Lives
The sale of one rare and beautiful car will benefit children undergoing treatment for life-threatening diseases.
-
Connecting to St. Jude at Work
stjudeatwork.org helps companies who want to include St. Jude in their workplace giving programs.
-
Research Highlights
Read recent highlights from St. Jude, including honors and awards, therapies for defects of brain tumor mutations, and the importance of reducing glucocorticoid resistance.
-
The Beauty of Giving
"Any little thing I can do to help a child is a beautiful gift,” says supermodel and actress Lily Aldridge.
-
Hope Through Change
The Ependymoma Awareness Day celebration symbolized hope through change with a release of butterflies.