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'Good' And 'Evil' Clones Of Acute Lymphoblastic Leukaemia cells

at the time of diagnosis, indicating that they were involved in the mechanism of relapse.

'My research indicates that these are not different leukaemias, but a smaller population of related cells that are naturally more aggressive than the major clone. The problem is that they are present at such low levels, hidden behind the obvious leukaemia; the patient would appear to be responding well to treatment with the major leukaemia clones dying, but, in fact, the small number of subclones can survive therapy and cause a relapse.'

The researchers found that the presence of the subclone at diagnosis correlated significantly with the length of the first clinical remission, and the more of the subclone that was present, the quicker the patient relapsed.

Ms Choi said: 'I believe it is important to know that these cells are actually more resistant and aggressive from the very beginning, like a evil twin, if you like. While the 'good' twin, or the major clone, appears to be responding well – and lulling the clinicians into a false sense of security – the 'evil' twin, or subclone that is identified too late because of their small numbers, can cause relapse, by which time they are present in very high numbers. Knowing this, we can identify such patients early on in their treatment and focus on new therapies that target the right cell/clonal population so that we may be able to improve the outcome for this special group of patients who relapse early.

'Patients who relapse early usually have a particularly poor outcome, and if we could prevent the relapse that is inevitable under the current treatment regime, then we might be able to make a big difference to these children's survival.'

The researchers believe that, in those patients where they were unable to detect subclones, the cells may have existed, but in numbers too low to be detected by current methods, and they are working to improve the PCR technique in order to increase
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