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Test Predicts Relapse for Pediatric Leukemia

CancerWise - August 2007

A simple blood test just two weeks after initial chemotherapy treatment predicts chances for relapse and survival in children and young adults with acute leukemia, according to recent study results.

Significance of results

The study, which was reported at the annual American Society of Pediatric Hematology/Oncology's meeting in May, could help doctor's worldwide improve treatment of acute myelogenous leukema (AML) and acute lymphocytic leukemia (ALL).

Being able to predict the chance of relapse may help:

  • Doctors decide how aggressively to treat patients
  • Researchers develop therapies to battle leukemia cells

"By tweaking the immune system through chemotherapy, immune modulators or oral supplements, we might help a patient's body better fight leukemia," says Guillermo De Angulo, M.D., a researcher and fellow at the Children's Cancer Hospital at M. D. Anderson. "This test could also help us identify patients who would benefit from less chemotherapy."

Research method

Blood samples were taken from 171 patients who started treatment for AML or ALL at M. D. Anderson between 1995 and 2005. Patients were 21 years old or younger when diagnosed.

Researchers analyzed the blood samples for absolute lymphocyte count (ALC), a measure of normal immune cells found on every complete blood count report. Lymphocytes are a type of white blood cell that help fight infection.

Primary results

Results of ALC levels in the blood on days 15, 21 and 28 after chemotherapy were a strong predictive factor for treatment success, De Angulo says. ALC levels are considered low if they are below 350 cells/mcL.

AML patients with:

  • Low ALC levels had a poor five-year overall survival rate of 28%
  • Higher ALC levels had an excellent overall survival rate of 85%

ALL patients with:

  • Low ALC levels had a poor overall survival rate of 55%
  • Higher ALC levels had a six-year survival rate of 87%

Additional results

The researchers also found that ALC helped predict survival in young patients with non-Hodgkin's lymphoma and Ewing's sarcoma, a bone cancer.

Background

AML and ALL are the most common types of childhood leukemia. The National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) data has the latest statistics on the disease.

According to SEER, the average survival rates are:

  • 40% for AML
  • 80% for ALL

What's next?

Researchers plan to measure ALC levels of newly diagnosed patients during chemotherapy and analyze lymphocyte subsets to see which ones impact prognosis most.

They hope their findings will be used to help physicians around the world make decisions on how aggressively to treat patients, says senior author Patrick Zweidler-McKay, M.D., Ph.D., an assistant professor with the Children's Cancer Hospital.

"Many developing countries lack the latest technologies and treatment options that we have here in the United States," he says. "A complete blood count test is a universal, inexpensive test. There is the potential for physicians worldwide to look at the ALC count only two weeks into treatment to help determine whether the patient will require alternative treatments."

– From staff reports

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© 2014 The University of Texas MD Anderson Cancer Center