Featured Research

from universities, journals, and other organizations

Improved diagnostic test benefits children with acute myeloid leukemia

Date:
September 10, 2012
Source:
St. Jude Children's Research Hospital
Summary:
Early treatment response is a powerful predictor of long-term outcome for young patients with acute myeloid leukemia (AML). The information can help physicians decide whether a more intensive approach is needed. Investigators have identified the best test for measuring that response and guiding therapy.

Early treatment response is a powerful predictor of long-term outcome for young patients with acute myeloid leukemia (AML). The information can help physicians decide whether a more intensive approach is needed. Research led by St. Jude Children's Research Hospital investigators has identified the best test for measuring that response and guiding therapy.

The method uses a laboratory technique called flow cytometry, which makes it possible to identify a single cancer cell in 1,000 normal cells that remain in patient bone marrow after the initial intensive weeks of chemotherapy. St. Jude investigators were instrumental in developing the test for identifying very low levels of cancer called minimal residual disease.

An analysis published in the September 10 online edition of the Journal of Clinical Oncology showed that checking for minimal residual disease by flow cytometry was better than two other widely used methods for predicting patient survival. The results help identify who might benefit from more intensive therapy, including bone marrow transplantation.

"These results will help establish flow cytometry testing for minimal residual disease as a routine tool for guiding therapy of acute myeloid leukemia and identifying patients early who are at risk of treatment failure," said Hiroto Inaba, M.D., Ph.D., an associate member of the Department of Oncology at St. Jude. He is the study's first and corresponding author.

Flow cytometry uses a laser to help distinguish cancer cells from normal cells based on different cell surface markers and other molecules. Dario Campana, M.D., Ph.D., led the successful St. Jude effort to develop the test about 15 years ago. Campana, now at the National University of Singapore, is the paper's senior author.

Such testing is widely used to guide treatment of the most common childhood cancer, acute lymphoblastic leukemia (ALL). AML targets different white blood cells than ALL does. AML also affects fewer children and adolescents, about 500 annually in the U.S., and has a lower survival rate. Although 94 percent of St. Jude ALL patients can now look forward to becoming long-term survivors, the figure is 71 percent for young AML patients. AML treatment response is evaluated on day 22 of therapy as well as at the end of each treatment phase and serves as a powerful predictor of patient survival. The results are used to guide ongoing therapy and identify patients who are candidates for more intense treatment.

For decades, physicians have relied on the microscope to evaluate patient response to therapy. Patients are considered to be in remission if a bone marrow examination finds cancer cells account for fewer than five in 100 cells. Flow cytometry and another laboratory technique called polymerase chain reaction (PCR) were also developed to help gauge treatment response. PCR is used to monitor genes created when chromosomes break and swap pieces. The genes are found in about half of all pediatric AML cases.

This study is the most comprehensive effort yet comparing the power of the three approaches to predict the AML treatment outcome. The work involved 203 AML patients enrolled in a clinical trial called AML02. St. Jude led the multi-institution study of young AML patients whose disease was diagnosed between 2002 and 2008. The project marked the first time minimal residual disease was used to guide therapy. During the study researchers examined 1,514 patient bone marrow samples by flow cytometry. Of those samples, 1,382 also had information regarding microscopic evaluation and 508 of PCR testing.

The analysis showed that minimal residual disease measured by flow cytometry was an independent predictor of patient outcome. Finding even one leukemia cell in 1,000 normal cells in bone marrow after the first or second round of therapy was associated with a worse prognosis and a greater risk of relapse or treatment failure.

Researchers concluded microscopic examination had limited value for gauging treatment response. Problems ranged from an inability to distinguish between cells destined to become leukemia cells and normal blood cells to classifying about 10 percent of patients as being in remission when flow cytometry identified leukemia cells in the same bone marrow.

Investigators also concluded that flow cytometry rendered PCR testing unnecessary for most AML patients. The analysis found PCR testing generally overestimated the presence of leukemia cells. In this study, PCR identified 197 of 311 patient samples as containing leukemia cells. Flow cytometry of the same samples showed just 19 actually harbored detectible minimal residual disease. Researchers did find PCR testing valuable in predicting outcome and guiding therapy for a subgroup of AML patients with mixed lineage leukemia (MLL) gene changes.

The other authors are Elaine Coustan-Smith, National University of Singapore; Xueyuan Cao, Stanley Pounds, Sheila Shurtleff, Susana Raimondi, Jeffrey Jacobsen, Raul Ribeiro, Wing Leung, James Downing, Ching-Hon Pui and Jeffrey Rubnitz, all of St. Jude; Kathleen Wang and Mihaela Onciu, both formerly of St. Jude; Gary Dahl, Lucile Packard Children's Hospital and Stanford Cancer Center, Palo Alto, CA.; W. Paul Bowman, Cook Children's Medical Center, Fort Worth; Jeffrey Taub, Children's Hospital of Michigan, Detroit; and Barbara Degar, Dana-Farber Cancer Institute, Boston.

The research was supported in part by grants (CA115422, CA023944 and CA021765) from the National Cancer Institute at the National Institutes of Health and ALSAC.


Story Source:

The above story is based on materials provided by St. Jude Children's Research Hospital. Note: Materials may be edited for content and length.


Journal Reference:

  1. Hiroto Inaba, Elaine Coustan-Smith, Xueyuan Cao, Stanley B. Pounds, Sheila A. Shurtleff, Kathleen Y. Wang, Susana C. Raimondi, Mihaela Onciu, Jeffrey Jacobsen, Raul C. Ribeiro, Gary V. Dahl, W. Paul Bowman, Jeffrey W. Taub, Barbara Degar, Wing Leung, James R. Downing, Ching-Hon Pui, Jeffrey E. Rubnitz, and Dario Campana. Comparative Analysis of Different Approaches to Measure Treatment Response in Acute Myeloid Leukemia. Journal of Clinical Oncology, September 10, 2012 DOI: 10.1200/JCO.2011.41.5323

Cite This Page:

St. Jude Children's Research Hospital. "Improved diagnostic test benefits children with acute myeloid leukemia." ScienceDaily. ScienceDaily, 10 September 2012. <www.sciencedaily.com/releases/2012/09/120910173405.htm>.
St. Jude Children's Research Hospital. (2012, September 10). Improved diagnostic test benefits children with acute myeloid leukemia. ScienceDaily. Retrieved July 22, 2014 from www.sciencedaily.com/releases/2012/09/120910173405.htm
St. Jude Children's Research Hospital. "Improved diagnostic test benefits children with acute myeloid leukemia." ScienceDaily. www.sciencedaily.com/releases/2012/09/120910173405.htm (accessed July 22, 2014).

Share This




More Health & Medicine News

Tuesday, July 22, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Gilead's $1000-a-Pill Drug Could Cure Hep C in HIV-Positive People

Gilead's $1000-a-Pill Drug Could Cure Hep C in HIV-Positive People

TheStreet (July 21, 2014) New research shows Gilead Science's drug Sovaldi helps in curing hepatitis C in those who suffer from HIV. In a medical study, the combination of Gilead's Hep C drug with anti-viral drug Ribavirin cured 76% of HIV-positive patients suffering from the most common hepatitis C strain. Hepatitis C and related complications have been a top cause of death in HIV-positive patients. Typical medication used to treat the disease, including interferon proteins, tended to react badly with HIV drugs. However, Sovaldi's %1,000-a-pill price tag could limit the number of patients able to access the treatment. TheStreet's Keris Lahiff reports from New York. Video provided by TheStreet
Powered by NewsLook.com
$23.6 Billion Awarded To Widow In Smoking Lawsuit

$23.6 Billion Awarded To Widow In Smoking Lawsuit

Newsy (July 20, 2014) Cynthia Robinson claims R.J. Reynolds Tobacco Company hid the health and addiction risks of its products, leading to the death of her husband in 1996. Video provided by Newsy
Powered by NewsLook.com
Tooth Plaque Provides Insight Into Diets Of Ancient People

Tooth Plaque Provides Insight Into Diets Of Ancient People

Newsy (July 19, 2014) Research on plaque from ancient teeth shows that our prehistoric ancestor's had a detailed understanding of plants long before developing agriculture. Video provided by Newsy
Powered by NewsLook.com
Contaminated Water Kills 3 Babies in South African Town

Contaminated Water Kills 3 Babies in South African Town

AFP (July 18, 2014) Contaminated water in South Africa's northwestern town of Bloemhof kills three babies and hospitalises over 500 people. The incident highlights growing fears over water safety in South Africa. Duration: 02:22 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins