Childhood Cancer

Acute Lymphoblastic Leukemia (ALL)

Childhood acute lymphoblastic leukemia (ALL) is cancer of the white blood cells, the cells that help fight infection. ALL is the most common form of childhood leukemia.

Latest Acute Lymphoblastic Leukemia (ALL) grants

Lisa Jacola, PhD, Principal Investigator
St. Jude Children's Research Hospital
Psychosocial Grants, Awarded 2016
Bruce Compas, PhD, Principal Investigator
Vanderbilt University
Psychosocial Grants, Awarded 2016
Michael Engle, MD/PhD, Principal Investigator
University of Utah
Reach Grants, Awarded 2016

Acute Lymphoblastic Leukemia (ALL) Heroes

Latest Acute Lymphoblastic Leukemia (ALL) blog posts

April 28, 2017

by Trish Adkins

When a child is first diagnosed with leukemia, the goal is to force the disease into remission. The treatment protocol is long and grueling—at least 2 1/2 years of chemotherapy, lumbar punctures and clinic visits. Today, children diagnosed with the most common form of pediatric leukemia—acute lymphoblastic leukemia (ALL)—have a high cure rate. The discovery of genetic differences that can increase a child’s risk of relapse has helped some of the highest risk patients reach remission. 

But, not all children with ALL reach remission. When they relapse, the second round of treatment is much more intense than the first says Dr. Todd Druley, ALSF Scientific Advisory Board Member and Assistant Professor of Pediatrics, Developmental Biology and Genetics at Washington University.  

Dr. Druley says the reason lies within the genetic drivers of the child’s specific type of leukemia. Better outcomes and cures will be found with continued genetic studies, innovation in technology and targeted treatments.

Understanding Leukemia
A diagnosis of leukemia is suspected after a blood test and confirmed by a bone marrow biopsy. The cells that make blood reside primarily in the bone marrow and when a child has leukemia, one of those cells becomes cancerous and overruns the other healthy cells.

While most childhood leukemia diagnoses are ALL, children are also diagnosed with acute myeloid leukemia (AML), chronic lymphoblastic leukemia (CLL), chronic myeloid leukemia (CML), and juvenile myelomonocytic leukemia (JMML). The acute form of the disease will grow suddenly—meaning the leukemia is spreading rapidly and outnumbering healthy cells and a child can become very sick quickly. 

Managing Risk Factors
One of the early breakthroughs in the treatment of childhood leukemia was to better understand the genetic differences between adult and childhood forms of the disease. Now, researchers have deconstructed the disease even further, giving them the ability to manage the risk factors for newly diagnosed patients. 

“Ten years ago, we did not appreciate the genetic differences inherent to leukemia and we thought most children had a standard risk. Now, we can see the subtypes of leukemia more precisely and provide the correct intensity of treatment,” said Dr. Druley

This helps children with both low and high-risk leukemia. Children with lower risk factors can receive a less intense treatment and therefore minimize long term side effects (which can include cardiac damage, developmental delays and fertility issues). 

If a relapse occurs, doctors now have more tools to battle the disease including CAR T cell immunotherapy, which works to harness the body’s immune system to attack the cancer cells. This therapy uses a patient’s own genetically engineered T cells (an immune cell that attacks things that are foreign to the body) to attack cancer cells that have been hiding from the immune system. 

Hope in the DNA
Genetic studies have also helped doctors understand infant ALL and AML (leukemia less than 12 months of age), which has significantly lower cure rates compared to leukemia in older children. Dr. Druley’s research suggests that babies who have leukemia appear to have inherited a genetic predisposition that makes them highly susceptible to developing the disease. 

Dr. Druley’s research continues to focus on determining the genetic drivers that predispose children to cancer and how to mitigate the effects of these genetic mutations and stop cancer formation. Understanding these genetic markers can also open the door to understanding how to treat other types of childhood cancer.

Scientists have discovered the same mutations in blood cells, also exist in solid tissue tumors, which helps provide critical clues into what makes a variety of childhood cancer types tick. 

“Science is telling us that treating cancer by its tissue or origin ( blood, lung, brain, etc) is often less effective than treating the genetic type of the tumor, guiding us to tailor therapy in whole new and exciting way,” said Dr. Druley.

Read more about Dr. Druley’s research here.

 

April 27, 2017

More and more research is focused on harnessing the body’s immune system to target and destroy cancer cells. One type, known as CAR T cell immunotherapy, is offering new hope and cures to patients with relapsed acute lymphoblastic leukemia (ALL). Here’s everything you need to know about CAR T cell immunotherapy:

What is immunotherapy?
Immunotherapy recruits the body’s own immune system to identify and kill cancer cells. Cancer cells hide from the immune system—convincing the body that they belong. As a result, cancer cells can grow without interference. Immunotherapy treatments activate the individual’s immune system so it can see cancer cells among the healthy cells, stop them from growing and kill existing cancer cells. 

What are T cells?
T cells are a type of white blood cell that works with the body’s immune system to help identify and destroy foreign invaders—like a virus. T cells appear when the body identifies an infection or injury; they replicate quickly in order to attack. Once their job is complete, the T cells decrease in number. When a child has leukemia, the T cells cannot see the cancer cells and therefore, they do not go to work fighting the cancer cells, as they would a virus. 

What is the “CAR” part of CAR T cell immunotherapy?
CAR stands for “Chimeric Antigen Receptor.” This lab-created cell modification takes the blindfold off T cells, allowing them to recognize cancer cells. 

How does CAR T cell immunotherapy work?
Making a T cell “see” cancer cells begins with collecting a child’s T cells. Then, those T cells are genetically modified with the addition of the chimeric antigen receptor (that’s the CAR part). The chimeric antigen receptor allows T cells to see the cancer cells. Once the child receives the newly modified T cells, the immune system goes to work. The T cells multiply, attacking the cancer until it is gone. CAR T cells have shown remarkable success in the treatment of relapsed leukemia and have the potential to be a tool in the fight against other childhood cancers such as brain tumors and neuroblastoma. 

What are side effects of CAR T cell immunotherapy?
Modified T cells release cytokines, which are chemical messengers that help the T cells destroy foreign invaders. Sometimes, there can be a rapid release of cytokines and this can cause extremely high fevers and extreme drops in blood pressure. Several researchers have used complementary therapies to stop cytokine release syndrome and are also working to understand the genetic drivers of cytokine release syndrome. 

What potential does this have for other types of cancer?
For now, CAR T cell immunotherapy offers the most promise for leukemia. However, understanding how modified T cells attack blood cancers can lead to more discoveries on how these cells could also lead to cures for solid tissue tumors. 

Who has CAR T cell immunotherapy helped?
CAR T cell immunotherapy could offer promise for many children battling relapsed ALL. In our Spring 2017 newsletter, we shared the story of how ALSF-funded Young Investigator, Dr. Rebecca Gardner at Seattle Children’s Hospital helped a young girl reach remission for her relapsed leukemia. Read more here.

 

April 5, 2017

by Trish Adkins, ALSF staff

Moments before Ruth Ciamarra found herself lying on a gurney next to her 5-year-old daughter Anna, doctors announced that Anna had leukemia and needed treatment immediately.

“My hearing went out; I was pretending to listen and nodding along with everything the doctor said. Then I interrupted the doctor and said ‘I’m about to pass out,’ as I tilted backward,” said Ruth. 

Earlier in the day, Ruth took Anna to her pediatrician to rule out a strep throat infection. Her symptoms did not seem particularly serious and Ruth expected a routine diagnosis, so she left her husband at home with their other daughter. There was a fever that came and went, causing Anna, who just started Kindergarten, to be sent home from school a couple of times. 

At the pediatrician, the doctor felt Anna’s abdomen and observed that she had an enlarged spleen. He gave her a rapid mononucleosis test. The test was positive. The doctor sent Ruth and Anna on their way with a diagnosis of “mono.”

But something about the diagnosis did not seem right to Ruth. Trusting her gut, she drove to the nearest children’s hospital. After several hours and tests later, the family had a diagnosis: high risk T-cell acute lymphoblastic leukemia (ALL).

When Ruth and Anna left the house that day, they never thought they’d end up in the Pediatric ICU with a leukemia diagnosis.

“Now, I am dealing with this world I did not know anything about,” said Ruth.

Everything moved quickly. After regaining her bearings, Ruth called her brother and husband—who both were equally shocked at what was happening. It would be months before Ruth could say the word, “cancer”; it was simply too hard to believe this was happening to her daughter. 

Anna’s blood tests revealed some critical issues that needed immediate attention—extremely elevated white blood cell counts and particularly low potassium levels. Without Ruth’s instinct that something was amiss, Anna’s condition would have quickly worsened. 

Anna quickly began treatment to stabilize her condition. After 10 days in the PICU, Anna started the marathon treatment protocol for ALL—2 years of in and outpatient therapies that include chemotherapy, lumbar punctures, transfusions and constant diagnostic testing to make sure Anna is tolerating and responding to the treatment. 

As Anna continues treatment, the Ciamarra family is also using their newfound life as a childhood cancer hero family to raise awareness and funds by hosting lemonade stands. 

“I’m never going to be a researcher—but there are so many things I can do to facilitate that research with ALSF and awareness,” said Ruth. 

Anna is now 7-years-old and 18 months into her treatment. The Ciamarra family hosts lemonade stands and is planning a stand with their school. In addition, the family is serving as one of the 2017 National Lemonade Days Hero Ambassadors. Read more about Anna’s story here.