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| Detailed Guide: Leukemia - Children's |
What's New in Leukemia Research and Treatment? |
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Researchers are now studying the causes, diagnosis, supportive care,
and treatment of leukemia at many medical centers, university
hospitals, and other institutions.
Genetics
As noted in the section "Do
We Know What Causes Childhood Leukemia?," scientists are
making great progress in understanding how changes in DNA can cause
lymphocytes and bone marrow stem cells to develop into leukemia.
Understanding the gene changes (such as translocations or extra
chromosomes) that often occur in leukemia gives us insight into why
these cells may grow out of control, and why they do not develop into
normal, mature cells.
This progress has already led to vastly improved and highly sensitive
tests for detecting this disease. The polymerase chain reaction (PCR)
test, for example, can identify very small numbers of leukemia cells
based on their gene translocations or rearrangements. This test can
find one tumor cell among a million normal cells. It is useful in
determining how completely the leukemia has been destroyed by
treatment, and whether a relapse will occur if further treatment is not
given.
Another test called DNA microarray analysis is being studied in many
cancers. This test can look at hundreds of gene changes in the cancer
cells at the same time. Scientists hope to use this test to be better
able to classify a child's prognosis. They also hope to find genetic
changes that may be targets for new kinds of drugs.
Over time, this information may be used in developing gene therapy.
This treatment would replace the abnormal DNA of cancer cells with
normal DNA in order to restore normal controls on cell growth.
Clinical Trials
Most children are treated for leukemia at major medical centers, where
treatment often involves taking part in clinical trials to provide the
most up-to-date care. Several important questions are now being studied
in clinical trials. Among them are:
- Why
do 30% of children with acute lymphocytic leukemia (ALL) relapse, and
how can this be prevented?
- Are
there other prognostic factors that will help identify which children
need more or less intensive treatment?
- Can
acute myelogenous leukemia (AML) be treated more effectively by using
more intensive chemotherapy, followed by growth factors to help restore
the child's normal bone marrow function?
- Can
chemotherapy drug resistance in AML be reversed?
- Are
there better drugs or combinations of drugs available for treating
leukemia?
- Can
drugs, toxins, or radiation be specifically targeted to the leukemic
cells by using manmade antibodies? Such antibodies can now be designed
to specifically seek out leukemia cells, which are then destroyed by
the drug, toxin, or radiation.
- Can
naturally produced "biologic response modifiers" help the body's immune
system fight the leukemia cells?
- When
exactly should a stem cell transplant be used to treat ALL or
AML?
- How
effective are stem cell transplants in children who don't have a
brother or sister who is a good tissue type match?
- Can
a second stem cell transplant help children who relapse after a first
stem cell transplant?
- Can
the outlook for children with ALL with a translocation between
chromosomes 9 and 22 be improved? Children whose leukemia cells have
this translocation, known as the "Philadelphia chromosome", tend to
have a lower cure rate than others with ALL. Imatinib (Gleevec) and
dasatinib (Sprycel), drugs that specifically kill cells with this
translocation, have been very helpful in treating certain leukemias in
adults. Studies are now under way to see if adding these drugs to
chemotherapy can improve treatment outcomes.
Revised: 08/19/2007
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