19 December 2022

Dutch researchers have revealed results of a trial of a new treatment protocol, which they believe is a significant step towards “curing” children with acute lymphoblastic leukaemia (ALL).

Professor Dr Rob Pieters, medical director and paediatric oncologist at the Princess Máxima Centre for paediatric oncology in the Netherlands, presented the results of the ALL-11 treatment protocol to the annual conference of the American Society of Hematology.

He and his team trialled an adapted treatment in specific groups of children with leukaemia, including children with a deletion of the Ikaros gene (IKZF1), treating more than 800 children between April 2012 and July 2020.

The children with Ikaros-deleted leukaemia received an extra year of chemotherapy in the ‘maintenance phase’ in addition to the first two years of treatment. This resulted in a threefold reduction in risk of the cancer returning; cancer returned in 9% of cases, compared to 26% of the children in the previous treatment protocol.

Of those who had the new protocol, 87% with Ikaros leukaemia survived their disease for five years without their cancer returning. This was an improvement on the 72% in the previous protocol.

The extra year of chemotherapy meant the cohort had a slightly higher risk of infection, but these were treatable.

In the ALL-11 protocol, the team also looked at the benefit of a less intensive treatment plan for three groups of children, including children with ETV6-RUNX1 leukaemia, linked to a very high chance of recovery, and those with Down’s syndrome who experience more severe side effects.

These children received a regimen which reduced or omitted anthracycline chemotherapy. This reduced regimen was successful as they had the same or even a better chance of survival, while their quality of life improved due to a lower risk of infections and damage to the heart.

Prof Pieters said: “The five-year survival rate for children with acute lymphoblastic leukaemia has increased enormously since the 1960s, from zero to 94%, but the last steps are the most difficult.

“We are now one step closer to curing all children with ALL. We have also largely been able to remove a drug that poses a risk of heart damage from the treatment of children with a less aggressive form of the disease. The latest results for children with leukaemia therefore fit in perfectly with our mission: curing more children with cancer, with fewer side effects.”

Source: ASH December 2022



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