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Acute Lymphoblastic Leukemia, the Most Common Childhood Cancer, Is Curable Without Preventive Cranial Radiation
Date:6/24/2009

er 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
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SOURCE St. Jude Children's Research Hospital
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