Navigation Links
Acute Lymphoblastic Leukemia, the Most Common Childhood Cancer, Is Curable Without Preventive Cranial Radiation

St. Jude study shows personalized chemotherapy can improve cure rate and avoid the use of radiation in acute lymphoblastic leukemia treatment

MEMPHIS, Tenn., June 24 /PRNewswire-USNewswire/ -- Childhood acute lymphoblastic leukemia (ALL) can be successfully treated using a carefully personalized chemotherapy regimen without cranial radiation, investigators at St. Jude Children's Research Hospital have found. Such radiation of the brain was once a standard ALL treatment to prevent recurrence of the leukemia in the central nervous system (CNS).

Despite radiation's success in treating ALL, it produces side effects that include second cancers, stunted growth, hormone imbalances and cognitive deficits. Optimized use of anticancer drugs, especially those instilled directly into the spinal fluid, have enabled clinicians to reduce radiation use, and only patients at highest risk for relapse have received cranial radiation.

Now, St. Jude researchers have established that radiation can be safely eliminated in all patients with the use of highly effective chemotherapy regimens. The findings appear in the June 25, 2009, issue of the New England Journal of Medicine.

"Cranial radiation was an invaluable treatment when it was introduced by St. Jude oncologists in the mid-1960s," said Ching-Hon Pui, M.D., chair of the St. Jude Department of Oncology and an American Cancer Society Professor. "It controlled CNS leukemia and boosted the cure rate for ALL from only 4 percent to 50 percent. But radiation's side effects led to the steady reduction of dosages and limited use to the highest-risk patients." According to Pui, the paper's lead author, about 20 percent of the approximately 3,400 cases of childhood ALL diagnosed in the U.S. each year are still treated with radiation. In some developing countries, radiation continues to be used in the majority of children with ALL.

"Over the years, St. Jude investigators have identified many important risk factors for CNS relapse and optimized chemotherapy treatment, leading to improved control of CNS relapse," Pui said. "Our success led us to believe that we could safely eliminate the use of cranial irradiation in all patients, and this study clearly demonstrates that to be true."

The study involved 498 patients treated for ALL at St. Jude and Cook Children's Medical Center in Fort Worth, Texas, between 2000 and 2007. The risk of relapse was determined by measurement of residual leukemia cells (so-called minimal residual disease) that were present after remission induction treatment. The measurement of minimal residual disease was used to modify therapy based on the level of disease detected. This measurement is the most important prognostic indicator, according to Dario Campana, M.D., Ph.D., vice chair for laboratory research in the St. Jude Department of Oncology and a co-author of the paper. "The combined use of immunological and molecular methods allows us to study 100 percent of the patients for levels of minimal residual disease, an unprecedented rate of success," Campana said.

St. Jude investigators applied personalized therapy based on molecular genetics of ALL, pharmacogenetic traits of patients and pharmacodynamic principles. "We prospectively determined the activity of drug-metabolizing enzymes of each patient and adjusted the dosage of chemotherapy accordingly," said Mary Relling, Pharm.D., chair of the St. Jude Department of Pharmaceutical Sciences and senior author of the paper. "Personalized therapy that we use avoids over- or under-treatment to maximize the cure rate while preventing excessive toxicity."

The researchers reported that this therapy produced a projected cure rate of 90 percent for all the patients, which is the best treatment result reported to date. This cure rate serves as a benchmark for others in the field. To assess whether cranial irradiation would have made a difference in CNS relapse, they compared the outcomes of 71 patients whose leukemias would have qualified them for irradiation with the outcomes of 56 patients who had received such irradiation in the past. The researchers found that the 71 patients, in fact, had significantly better complete remission than the 56 patients who had been irradiated.

"The bottom line is that not only did we get outstanding treatment responses in these patients, many of whom would have otherwise received irradiation, but they will have a better quality of life because of the absence of its side effects," Pui said.

"In a way, these findings represent coming full circle," said Dr. William Evans, St. Jude director and CEO and a co-author of the paper. "St. Jude was the first to introduce cranial radiation as a treatment strategy that advanced the cure of childhood ALL to 50 percent. Now, St. Jude is the first to show that we can successfully eliminate irradiation by optimizing chemotherapy."

Other authors of this paper include Deqing Pei, John Sandlund, Sue Kaste, Raul Ribeiro, Jeffrey Rubnitz, Susana Raimondi, Mihaela Onciu, Elaine Coustan-Smith, Larry Kun, Sima Jeha, Cheng Cheng, Scott Howard, Vickey Simmons, Monika Metzger, James Boyett, Wing Leung and James Downing (St. Jude); W. Paul Bowman and Amy Bayles (Cook Children's Medical Center); and Rupert Handgretinger (formerly of St. Jude).

The research was supported in part by the National Institutes of Health, the American Cancer Society F.M. Kirby Clinical Research Professorship and ALSAC.

St. Jude Children's Research Hospital

St. Jude Children's Research Hospital is internationally recognized for its pioneering work in finding cures and saving children with cancer and other catastrophic diseases. Founded by late entertainer Danny Thomas and based in Memphis, Tenn., St. Jude freely shares its discoveries with scientific and medical communities around the world. No family ever pays for treatments not covered by insurance, and families without insurance are never asked to pay. St. Jude is financially supported by ALSAC, its fundraising organization. For more information, please visit

SOURCE St. Jude Children's Research Hospital
Copyright©2009 PR Newswire.
All rights reserved

Related medicine technology :

1. Xenomics Announces Implementation of its First Diagnostic Test for Acute Myeloid Leukemia Into Clinical Practice
2. TorreyPines Therapeutics Completes Patient Enrollment in Phase IIb Clinical Trial of Tezampanel for the Treatment of Acute Migraine Headache
3. Quark Pharmaceuticals, Inc. Presented Positive Preclinical Results of Systemic RNAi Compound for Acute Renal Failure (ARF)
4. Quark Pharmaceuticals Extends Research Agreement with State University of New York for Proprietary siRNA Compounds for Acute Hearing Loss
5. Biopure Seeks Compassionate Use Protocol for Treatment of Acute Anemia
6. CuraGen and TopoTarget Initiate Phase I/II Clinical Trial of Belinostat (PXD101) Combination Therapy for Acute Myeloid Leukemia
7. Alseres Pharmaceuticals Announces Expansion of the Cethrin(R) Acute Spinal Cord Injury (SCI) Phase I/IIA Clinical Trial
8. Analysis Shows Vernakalant Hydrochloride Injection Increases Conversion to Normal Heart Rhythm in Acute Atrial Fibrillation Patients Treated Within 48 Hours of Onset
9. INVEGA(TM) Significantly Reduced Symptoms of Schizophrenia Compared to SEROQUEL(R) in Acutely Ill, Hospitalized Patients
10. Plavix(R) Indications Expanded in Japan to Include Patients with Acute Coronary Syndrome for Whom Percutaneous Coronary Intervention Is Being Planned
11. Tezampanel Meets Primary Endpoint in Phase IIb Clinical Trial in Acute Migraine Headache
Post Your Comments:
(Date:11/26/2015)... November 26, 2015 ... addition of the  "2016 Future Horizons ... Cell Surface Marker Testing Market: Supplier ... to their offering.  --> ... of the  "2016 Future Horizons and ...
(Date:11/25/2015)... 2015  Amgen (NASDAQ: AMGN ) today announced ... the United States (U.S.) Food ... candidate to Humira ® (adalimumab). Amgen believes this ... the FDA and represents Amgen,s first BLA submission using ... , M.D., executive vice president of Research and Development ...
(Date:11/25/2015)... 25, 2015 AAIPharma Services Corp./Cambridge Major ... at least $15.8  Million to expand its laboratories ... . The expansion will provide additional office ... growing demands of the pharmaceutical and biotechnology markets. ... will provide up to 40,000 square feet of ...
Breaking Medicine Technology:
(Date:11/28/2015)... (PRWEB) , ... November 28, 2015 , ... ... exchange technology and teleradiology services, has added Chris Hafey and Claude Hooton to ... at the Radiological Society of North America (RSNA) 2015 Annual Meeting and continues ...
(Date:11/28/2015)... ... 2015 , ... Pixel Film Studios is back again with ProPanel: Pulse ... are endless. Users have full control over angle of view, speed method, start point, ... sure to get heads to turn. , ProPanel: Pulse offers fully customizable pulsating shape ...
(Date:11/27/2015)... Denver, CO (PRWEB) , ... November 27, 2015 , ... ... U.S. cities are not changing the way that they are handling security in light ... increasing police and security presence in an attempt to stop an attack from reaching ...
(Date:11/27/2015)... ... 2015 , ... "When I was traveling, I was very ... "Many people catch diseases simply from sitting on such dirty toilet seats. I ... germs." , He developed the patent-pending QUDRATECS to eliminate the need to sit ...
(Date:11/27/2015)... ... 2015 , ... MPWH, the No.1 Herpes-only dating community in the world, revealed that over 50% ... More than 3.7 billion people under the age of 50 – or 67% of the ... first global estimates of HSV-1 infection . , "The data shocks us highly!" said ...
Breaking Medicine News(10 mins):