This national clinical trial for children with acute lymphoblastic leukaemia builds on the success of the previous trial, UKALL 2003, which pioneered a new molecular technique to stratify children into different treatment groups according to residual levels of leukaemic cells. This new trial will use the technique to monitor the effect of changes to the treatment regime in an attempt to save even more children.
The genetics of familial leukaemia
Dr Pamela Kearns
University of Birmingham
Birmingham, B15 2TT
1 April 2012
Clinical trials help us to find better ways of treating diseases. They allow us to test new treatments and ways of controlling symptoms.
Thanks to the ongoing series of childhood leukaemia trials, huge progress has been made in treating a disease which was almost universally fatal only 50 years ago.
The trials have enabled doctors to develop and refine treatment protocols for children with different types of leukaemia and different risk factors. This has driven up the survival rate to more than 80%.
Most children being treated for leukaemia in the UK will be given the opportunity to take part in a clinical trial. All families have the right to choose whether or not to take part – those who decline will receive the current standard treatment.
The aim of the new trial is to take survival even higher. It will build on the success of UKALL 2003, using the MRD test to routinely select treatment for children who are deemed either good or poor risk. Their treatment can be reduced or intensified but still achieve cure.
The MRD test will be used to monitor the effectiveness of an important change to the chemotherapy regime for children with ALL.
Doctors will use a drug called dexamethasone at a much earlier stage in treatment. Evidence suggests that this will reduce the number of children who relapse on treatment.
For more information on clinical trials and childhood cancer, see ‘A Guide to Clinical Trials’ published by the Childhood Cancer and Leukaemia Group.
The previous childhood ALL trial, UKALL 2003, closed in March 2010 after six years.
As part of UKALL 2003, doctors pioneered a new technique known as minimal residual disease (MRD) testing to determine how well children were responding to treatment and to predict how likely they were to relapse.
This enabled them to tailor each child’s treatment – so that only children at high risk of relapse were given the most intensive treatment. Since the treatments used for leukaemia carry the risk of some serious side effects, it is important that children are not given more treatment than they need.
MRD testing now takes place routinely during the treatment of children with ALL, with the costs now borne by the NHS. It is thought that this innovation will push the survival rate above 90%.
And, importantly, it will also protect children with lower risk leukaemia from the harmful side-effects associated with high doses of chemotherapy.
Dr Pamela Kearns