Graduation Bound: ALL


    Being an alumna will never be more fulfilling. Next year, Kate McCloskey will not only graduate from high school, but she will also graduate from St. Jude Children’s Research Hospital—with a degree in survival.

    At age 2, Kate was diagnosed with acute lymphoblastic leukemia (ALL) and underwent treatment at St. Jude for three years. “It’s incredible to be a survivor. It’s so hard to put into words. It’s the most incredible feeling,” exclaims Kate one early morning before a busy day of school, band practice and babysitting begins.

    Now ALL survivors like Kate and current patients have more to be excited about. A St. Jude study published in the August 2003 New England Journal of Medicine shows that survivors of ALL are considered officially cured if leukemia free for 10 years or more. The outlook is even rosier for survivors who did not receive radiation as part of their treatment.

    Survivors’ report card

    According to Ching-Hon Pui, MD, director of the Leukemia/Lymphoma division at St. Jude and lead author of the study, this discovery is important. “The good news is that patients who didn’t receive radiation survive exactly the same as the general population and survive normally, as best we can tell, because they have an employment rate and marital rate as good as the general population,” Pui says.

    “For those who had radiation, I think the message is that they need to pay attention to the development of second tumors. Even though most are benign, we still want early detection. But they can also be assured that their leukemia is cured.”

    The results stemmed from a long-term follow-up study of 856 patients treated between 1962 and 1992.
    “St. Jude is a unique institution because, unlike other institutions, we follow our patients practically forever,” Pui says. 

    “We focused on two major issues in this study,” says Melissa Hudson, MD, who directs the hospital’s After Completion of Therapy clinic and is a senior author of the report. “First, we wanted to know how our long-term survivors are doing as they are beginning to age, and whether the leukemia treatment specifically affects their mortality rates as compared to other people their same age and gender in the general population. We also wanted to know how their leukemia treatment affected specific areas of social functioning and social competence—marital rates, ability to get insurance and employment. We thought we were going to see more insurance discrimination, and we did not. Our survivors have comparable rates of insurance to other people their same age in the population.”

    Lifelong learning

    Pui and Hudson agree that survivors like Kate, who had radiation, should maintain healthy lifestyles to reduce the risk of getting second cancers. Kate says she has made it a priority in her life to be conscious of her health and to help her doctors. “Having cancer has made me more aware and should make all survivors a lot more aware,” Kate says. “As a person who had childhood cancer, you have to tell your doctor your health history, and it can be frustrating. It’s hard to face the reality that you’re going to have medical problems, but it’s part of being a survivor.”

    Only 53 percent of the survivors participating in the study had undergone medical examinations within the previous year. The rate for the general population is 80 percent. “We’re trying to motivate our survivors,” says Hudson. “They do need to have a relationship with a health care provider who knows about their history—not so they have to panic every time, but so that the health care provider is aware on a baseline of any physical or emotional issues experienced by the survivor.” Hudson says that clinicians can help former cancer patients learn about the current research that affects childhood cancer survivors as they age.

    According to Pui, current ALL and acute myeloid leukemia (AML) patients at St. Jude no longer receive radiation unless absolutely necessary. “We’re always concerned about radiation-related second cancer, and how the radiation can affect the patient’s neuropsychological functions,” he says. “There has been a trend over the years to reduce the amount of radiation and the number of patients who get radiation. Based on our studies over the past decade, we think we can possibly omit radiation altogether for all patients by intensifying other aspects of therapy without compromising their chance of cure.”

    By eliminating radiation, quality of life for patients will improve. “I hope that in three to five years’ time, we can tell the world it’s feasible to not radiate,” Pui says. “If we can prove we don’t need to give radiation to cure leukemia, survivors of leukemia can expect an even better quality of life in the future.”

    St. Jude is already moving in that direction. “This study provides more data to support the elimination of radiation as a front-line treatment for children with ALL,” Hudson says.

    As Kate approaches her eighteenth birthday and life without checkups at St. Jude, she has advice for all patients: “Be strong in yourself and have faith in yourself,” she says. “Even though it’s a long road, you will be stronger from within.”

    Reprinted from Promise magazine, autumn 2003