Taking leukemia treatment to the next level
Researchers at the University of Minnesota are working tirelessly to provide treatment programs that will improve survival rates for high-risk or relapsed patients with leukemia. Overall cure rates for certain types of childhood leukemia continue to improve.
Leukemia refers to cancers of the white blood cells, also called leukocytes. With leukemia, large numbers of abnormal, immature, white blood cells are produced in the bone marrow, crowding out red blood cells and platelets. Patients with leukemia suffer from anemia and bleeding problems, and they are also at increased risk for infection. Leukemia represent about 25 percent of all childhood cancers.
The university team has developed treatment options incorporating chemotherapy, phase I and II investigational agents, and other unique therapies being developed at the university. Researchers believe that collaboration, especially between the oncology/hematology and bone marrow transplant communities, is the key to taking leukemia treatment to the next level.
Umbilical cord blood transplants
The University of Minnesota is a world leader in umbilical cord blood (UCB) transplant. UCB has been used routinely as an alternative to bone marrow transplants, but one unit of UCB was not enough to treat adolescents or adults. A study funded by the National Cancer Institute and Children’s Cancer Research Fund found use of two units of UCB from two separate donors instead was more effective. The results were significant, and their protocol is now known as “The Minneapolis Regimen.”
Doctors found that patients developed two separate immune systems to fight the cancer cells, and the rate of leukemia recurrence dropped from 34 percent to 19 percent. More importantly, instead of a bone marrow transplant, this treatment can be used for adolescents and adults. The next step is a national study comparing one versus two-cord blood units in children with leukemia.
Understanding and alleviating the side effects of cancer therapy is always on the minds of physicians. By studying survivors, they can adjust the initial treatments for children diagnosed with leukemia. Doctors are studying the effects of treatment on all cancer survivors. Our researchers discovered that children treated for leukemia have an increased risk for heart disease at a young age. There are also increased risks for diabetes and secondary cancers. After a small study, researchers are preparing to move into a larger study to find the frequency and risks for long-term cardiac outcomes among survivors of childhood and adolescent cancers.
Understanding why patients relapse
Researchers don’t know why leukemia returns, but they have three general theories. Sometimes the disease is never extinguished due to a more resistant “mother cell,” which isn’t destroyed by chemotherapy. Another theory suggests that cancer develops when a patient born with DNA defects, or mutations, is exposed to an infection or toxin. Chemotherapy may eliminate the cancer but not the mutation, putting the patient at risk for a relapse or second leukemia.
A third possibility is that some patients may simply develop resistance to drugs used. Researchers at the University of Minnesota are researching these theories as they treat patients. They are particularly interested in patients who do not appear to have high risk leukemia and then relapse. These cases often lead to further discoveries about the biology of leukemia.
Children’s Cancer Research Fund: a committed research ally
We support the work of the University of Minnesota’s Childhood Leukemia Program as doctors seek to reduce the number of leukemia patients who relapse. “The greatest strides will be in tailored treatments,” said Burke. “In the early 80s, people realized that not all leukemia was the same. They didn’t understand T-cell or B-cell ALL. We know now that we can’t treat all patients the same. We need to identify the family tree, where the leukemia originated, and what it will respond to.”
A FACS Canto machine was provided by Children’s Cancer Research Fund supporters to identify better ways to monitor a patient’s response to therapy, to identify patients at high risk for treatment failure and to tailor treatments more precisely. “Because of what Children’s Cancer Research Fund provides, we can spend more time thinking about and exploring new ideas,” said Verneris. “This allows us breadth so we can dig deeper and become international experts.”
While doctors don’t know why leukemia returns, they do know that fewer children are relapsing today, thanks to the ability to identify those at highest risk earlier in the disease. As a result, doctors can start patients on a tailored treatment protocol much earlier. “Some people are doing lab-intensive, early-stage work,” Verneris said.
“If we can provide investigators with primary cells from patients, they would love it. We can supply patient samples to make their research better. We can also take their work and bring it back into the clinic. Taking science to the clinic or taking the clinic back to the lab – that is extraordinary. There are so many good ideas and projects at this university. We want to embrace these ideas, capture what’s happening here and move it forward. Because of Children’s Cancer Research Fund’s support, we can do these things.”