By 2000 around 80 percent of children were cured of the most common form of leukaemia, acute lymphoblastic leukaemia (ALL), and around 50 percent were being cured of acute myeloid leukaemia (AML).
Remarkably, the drugs used in 2000 were not much different from those used in the 1970s, but research and clinical trials changed the way these drugs were administered with doses ‘individualised’ for each patient, and we were much better able to manage side-effects, reducing treatment related fatalities.
In addition to the introduction of the MRD test across the NHS, our scientists began the development of a new test to guide treatment with a particular chemotherapy drug, 6-mercaptopurine.
This ground-breaking test screens the genetic profile of children with ALL to identify those whose metabolism breaks down the drugs very rapidly and for whom the standard dosage has little effect. These children can be given a higher dose of the drug, and those whose metabolism breaks down the drug more slowly and for whom the standard dose induces unacceptableside effects can be given less treatment.
Identifying stem cells
In 2008 a breakthrough study by Professor Mel Greaves at the Institute of Cancer Research in London confirmed the existence of stem cells in childhood ALL. The research, which we funded, identified these important cells in both identical twin sisters Olivia, who had leukaemia and Isabella, who was healthy.
Follow-up research is still underway to confirm exactly why some children with pre-leukaemic stem cells go on to develop leukaemia and others do not. The discovery of stem cells has also had profound implications for the direction of treatment and the possible prevention of this particular type of leukaemia.
Further intricate genetic research is showing that not only is one child’s leukaemia different from another’s, but within the many leukaemia cells there are genetic differences that need to be understood in order to develop treatments that are effective at killing all the leukaemia cells in a patient.
Boosting the effects of treatment
The turn of the century saw an increase in research into alternative treatment options that can be used alongside chemotherapy to reduce side-effects and increase survival rates. An example of this is immunotherapy, which genetically engineers cells to enhance the immune system in the fight against cancer. Immunotherapy techniques continue to be developed for children with leukaemia.