Comment: Classification system based on cytogenetics and treatment response identifies leukaemia patients with high-risk clinical features

Published: 5 Dec 2015

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Dr Wendy Stock - University of Chicago, Chicago, USA

Dr Stock talks to ecancertv at ASH 2015 about results from a Children's Oncology Group study that looked at using a real-time disease classification protocol based on clinical, biologic and early disease response measures for childhood B-lymphoblastic leukaemia (ALL).

The findings, presented by Dr Elizabeth Raetz of the University of Utah in Salt Lake City, USA, showed that the protocol could be used to identify children who may or may who may need intensified treatment after induction therapy.

The study involved over 10,000 children of whom around 5,000 met National Cancer Institute criteria for standard risk ALL and 2,700 were deemed high risk at the end of induction therapy. A large subset of children was identified who had favourable cytogenetic profiles and rapid responses to treatment resulting in high overall survival at 5 years. This suggests that there could be some children who would not benefit from further chemotherapy intensification.

Read the news story and watch the press conference for more information.

ASH 2015

Comment: Classification system based on cytogenetics and treatment response identifies leukaemia patients with high-risk clinical features

Dr Wendy Stock - University of Chicago, Chicago, USA

Doctor Elizabeth Raetz was also talking about two ways of looking at patients with acute lymphoblastic leukaemia. Can you tell me what she was doing and what the importance of that was?

This was a huge study of 10,000 children with acute lymphoblastic leukaemia who were treated on the Children’s Oncology Group trials in the United States and Canada. What this study showed was that by careful evaluation of this group of patients using both cytogenetics and molecular diagnostics for minimal residual disease they were able to define a group of patients who, based on just purely clinical features, who were previously thought to be very high risk patients actually had very good outcomes based on chromosome analysis and minimal residual disease.

And response rate came into this, was that with the MRD?

The MRD, what minimal residual disease is is the ability at a subclinical level to detect small numbers of cells that still represent the leukemic clone. We know that patients who have low minimal residual disease or absent minimal residual disease after four weeks of treatment have a very good prognosis. Some of the patients in the study were classified by clinical features before they were treated as being very high risk and yet when the factors of minimal residual disease were used to reclassify these patients it was found that there’s a small percentage of these patients who would have been thought to be very poor risk patients with a high relapse risk actually had very responsive disease and had very good outcomes and would spare these patients, then, from getting intensified treatment.

So that’s an important step forward for clinicians to spare that toxicity.

That is a very important step forward.