Chauvenet and his colleagues looked at the current chemotherapy prescribed for Acute Lymphblastic Leukemia (ALL), the most common childhood cancer diagnosed in the United States.
"While the cure rates for this cancer have dramatically improved over the years, many children have considerable long-term side effects, such as significant drops in IQ scores, growth failure and infertility," he said. "We wanted to identify patients whose cancer we could cure, while minimizing the long-term effects of the treatment."
Chauvenet and his colleagues used relatively limited amounts of chemotherapy for children identified as having an excellent chance of cure and monitored the group of 650 patients for about 12 years.
At the end of the study, the group discovered that 86.4 percent of patients were described as event-free survivors at the end of 10 years. And 95.9 percent were overall survivors at the end of the 10-year period. Event-free survivors were patients who had no relapses or second malignancies in the time frame. Overall survivors experienced one of those conditions, but were still living at the end of the study period.
"This showed us that using limited chemotherapy worked in a large number of cases with minimal complications," he said. "The next step would be to fine-tune the identification of those patients upfront so that long-term side effects could be avoided in as many patients as possible."
Chauvenet and his colleagues looked for factors that might predict which children would do well with less intensive chemotherapy drugs. They looked at factors such as gender, race, white blood cell counts, whether the patient had an extra copy of certain chromosomes, and at the patient's bone marrow count two weeks into diagnosis.
"What we found was that bone marrow count and extra chromosomes were the only two factors that played into whether our patients would have a reoccurrence or not do so well with lower doses of our chemotherapy regime," he said. "Upon diagnosis, we can now look for these factors and consider them when developing our treatment plans. Maybe we add a little more intensive therapy to our treatment to help patients with these particular factors to improve their outcomes."
ALL is the most common malignancy in children. About 3,500 children are diagnosed each year with this disease. Most have about an 80 percent chance of overall survival after eight years. Brenner Children's Hospital, part of Wake Forest University Baptist Medical Center, sees an average of 20 new patients each year affected with ALL.
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