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Acute lymphoblastic leukemia researchers seek breakthrough

St. Jude Childrens Research Hospital : 21 March, 2008  (Company News)
To raise the survival rate of adolescents and adults with acute lymphoblastic leukemia (ALL), researchers will need a more thorough understanding of the biology of this form of leukemia, including the role that genes play in therapies, reports Ching-Hon Pui, MD, chair of the Department of Oncology at St Jude Children's Research Hospital.
The increased cure rate for children with ALL will be difficult to replicate in older patients without considerable additional research, according to an article by St Jude Children's Research Hospital authors that appears in the March 22 issue of The Lancet.

Currently, adolescents treated for ALL do not fare as well as children; and among adults with ALL, only 30 to 40 percent are cured.

Cure rates for children with ALL - defined as 10 years of cancer-free survival - were about four percent when St Jude opened its doors in 1962; but by the end of that decade researchers showed for the first time that treatments using a combination of existing cancer drugs significantly improved ALL survival. Subsequent research at St Jude contributed in large part to the current high cure rate achieved in children with ALL over the past four decades

Today, paediatric ALL patients at St Jude have a cure rate approaching 90 percent, Pui said. 'We already have 94 percent surviving at five years.'

In The Lancet article, Pui and his colleagues noted that researchers are investigating two areas of molecular science that hold promise for improving the survival and quality of life of ALL patients, including adolescents and adults.

One is gene-expression profiling, which measures the amount of messenger RNA made by different genes in different cell types; and the other is pharmacogenetics. RNA is the decoded form of genes and is a signal that those genes have been active. Pharmacogenetics is the study of how genes influence a person's responses to drugs.

Some ALL specialists envision a time when oncologists use leukemic cell genetics and host pharmacogenetics to match specific treatments to individual patients.

'We need to know the leukemic cell genetics that affect drug sensitivity or resistance and what role pharmacogenetics plays in treatment to improve efficacy and decrease toxicity,' Pui said. 'That way, we don't over treat low-risk patients or under treat high-risk patients.'

Other authors of this paper include Les Robison (St Jude) and A Thomas Look (Dana-Farber Cancer Institute and Harvard Medical School, Boston).

The work was supported in part by grants from the National Institutes of Health and ALSAC.
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