Researchers are looking at the causes, diagnosis, and treatment of leukemia at many medical centers, hospitals, and other institutions.
Genetics of leukemia
Scientists are making great progress in learning how changes in a person's DNA can cause normal bone marrow cells to change into leukemia. Doctors are learning how to use these changes to help predict a person's outlook and whether they should get more or less intense treatment. As this information unfolds, it may be used to come up with an approach that uses newer targeted treatments against acute lymphocytic leukemia (ALL). Drugs like imatinib (Gleevec®) and dasatinib (Sprycel®) are now being used in people with a certain type of ALL.
A new lab technique is being studied to help find and classify different cancers. Instead of looking at single genes, this test uses a special method to look at the patterns of many different genes in the cancer cells at the same time. Some day this information may allow the doctors to tailor treatment to different people by predicting which chemo drugs are likely to be most effective for each patient. These studies may also shed light on changes inside ALL cells that we didn't know about before. This may help guide the development of new drugs.
Finding "hidden" disease (minimal residual disease)
Progress has also been made in finding leukemia cells after treatment when there may be so few leukemia cells that they cannot be found by routine bone marrow tests. A test called PCR can find one cancer cell among a million normal cells. This is helpful in seeing how well the chemo has destroyed the leukemia cells and whether a relapse is likely. Doctors are now trying to figure out whether patients with minimal residual disease will be helped by further or more intense treatment.
Better chemo
Studies are going on to find the best combination of chemo drugs (those with fewer side effects) and to figure out which patients will be helped the most from different types of treatment. Sometimes chemo does not work very well because the leukemia cells become resistant to it. Researchers are now looking at ways to prevent or reverse this resistance by using other drugs along with chemo. New chemo drugs are also being developed and tested.
Stem cell transplants
Studies are also being done to improve the stem cell transplant process and to predict which patients are most likely to be helped by this treatment. In people who have already had an allogeneic transplant and who relapse, doctors are studying donor leukocyte infusion. In this treatment, the patient gets an infusion of white blood cells (leukocytes) from the same donor who gave stem cells for the transplant. The hope is that the cells will boost the new immune system and add to the graft-versus-leukemia effect. Early study results have shown promise, but more research is needed.
Monoclonal antibodies
These are man-made immune system proteins that attach to certain molecules on the surface of the leukemia cells. One of them, rituximab (Rituxan®), is used to treat certain lymphomas. Researchers are now looking at whether rituximab might be helpful against ALL. Early results have been good, but it is still too early to know for sure. Studies of some other monoclonal antibodies to treat ALL are now under way.
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