Gene Expression Profiling Helps Predict Response to Treatment of Leukemia

Gene Expression Profiling Helps Predict Response to Treatment of Acute Lymphocytic Leukemia

According to a recent article published in The New England Journal of Medicine, expressions of specific genes help predict a patient’s response to standard therapy in those diagnosed with acute lymphocytic leukemia.

Acute lymphocytic leukemia (ALL) is a cancer of the bone marrow and lymph system. The bone marrow produces early blood-forming cells, called stem cells, which grow and mature into the three blood cell types: white blood cells, which fight infection; red blood cells, which carry oxygen to tissue; and platelets, which help blood to clot. ALL is characterized by uncontrolled production of immature lymphocytes (white blood cells), of which there are two types: B and T cells. These immature lymphocytes never mature enough to perform their specific function of fighting infection. In addition, these rapidly dividing cells crowd out and suppress the formation of other important blood cells, such as red blood cells, platelets and other white blood cells. ALL is an aggressive cancer that must be treated aggressively for optimal chances of a cure.

The field of genetics appears to be quickly emerging into the clinical setting in oncology. It is becoming increasingly clear that differences in genetic make-up or genetic sequences between patients with the same disease plays a role in the prognosis of the patient and ultimately, may play a large role in determining the optimal treatment strategies for each individual patient. Approximately 80% of pediatric patients with ALL respond to standard treatment, while 20% of patients do not respond to standard treatment.

Researchers recently analyzed gene expression in patients with ALL and possible associations with prognosis. This study included 173 children who were diagnosed with ALL. Gene expression profiles were compared between patients who responded to treatment, and those who did not respond. The 4 drugs utilized were vincristine, asparaginase, daunorubicin and prednisolone. Results revealed expression of 40 genes associated with response to vincristine, 35 genes associated with response to asparaginase, 20 genes associated with response to daunorubicin and 33 genes associated with response to prednisolone.

The researchers concluded that expression of specific genes are associated with response and cure to standard treatment used for pediatric ALL. Testing of these genes prior to treatment may provide individualized treatment options and ultimately, optimal outcomes for all patients with ALL, as patients with genes that are associated with no responses may opt for alternative treatment options. Parents with children diagnosed with ALL may wish to speak with their physician about the risks and benefits of participating in a clinical trial further evaluating genetic profiles. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (cancer.gov) and www.cancerconsultants.com. Personalized clinical trial searches are also performed on behalf of patients at cancerconsultants.com.

Reference: Holleman A, Cheok M, den Boer M, et al. Gene-Expression Patterns in Drug-Resistant Acute Lymphoblastic Leukemia Cells and Response to Treatment. The New England Journal of Medicine. 2004;351:533-542.

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