Treatment for B-cell and T-cell lineage acute lymphoblastic leukemia (B-ALL and T-ALL) has historically been similar. However, a distinct biology between these subtypes identified in recent years has led to changes in recommended standards of care.
This is the focus of a recently published study by two Children’s Minnesota kid experts, Dr. Nathan Gossai, pediatric oncologist and director of the leukemia and lymphoma program and Dr. Stuart S. Winter, chief of research and medical innovation. The study, “Central nervous system status is prognostic in T-cell acute lymphoblastic leukemia: a Children’s Oncology Group report,” was published in Blood, the flagship, peer-reviewed medical journal from the American Society of Hematology.
The study used two consecutive, international phase 3 clinical trials to determine the following:
- Patients with central nervous system (CNS)-1 and CNS-2 status have similar outcomes across two large studies with divergent therapies, including with and without cranial radiation therapy (CRT).
- Patients with CNS-3 T-cell acute lymphoblastic leukemia treated with nelarabine had similar overall survival (OS) as CNS-1 and CNS-2, and thus should receive nelarabine as standard of care.
This is the largest study of CNS status in T-ALL patients and will influence the standard of care for patients with CNS leukemia by limiting radiation exposure to patients and demonstrating the efficacy of novel therapies.
Risks of cranial radiation therapy (CRT) in kids
With the advancement of therapies, many physicians treat children and young adults with ALL without prophylactic CRT because there are well-established risks with CRT, including:
- Neurocognitive deficits, including impaired memory, attention, and processing speed
- Endocrine complications, including anterior pituitary deficits associated with deficiencies in growth hormone and thyroid hormone
- Increase evidence of secondary malignancies
- Decrease in executive function in dose-dependent fashion, especially in young kids
About acute lymphoblastic leukemia
Acute lymphoblastic leukemia (ALL) is a cancer that involves the white blood cells of the bone marrow. It is the most common leukemia diagnosed in children.
The malignant cells in ALL are lymphocytes, which escape the normal controls that direct the way they mature. Instead of aging in a way that allows them to do their part in helping to fight infection, they remain young, continue to multiply and are ineffective in fighting infection. These immature lymphocytes are called lymphoblasts, blasts or leukemic cells. There are many kinds of lymphocytes, including B–cell and T–cell lymphocytes. Leukemia can occur in any type of lymphocyte; the most common type of ALL is early or pre-B–cell leukemia.
About the cancer and blood disorders program at Children’s Minnesota
Children’s Minnesota is an established thought leader in pediatric hematology-oncology. Our clinicians provide a portal of access to experimental therapies for infants, children and young adults and have achieved international recognition for their leadership in pediatric medicine.
Children’s Minnesota’s leukemia and lymphoma program is one of the largest in the region. We provide access to the most current national and international treatment protocols for chemotherapy, radiation, and therapeutics. Our multidisciplinary team of kid experts includes pediatric specialists from a wide variety of disciplines, including radiation oncology, surgery, anesthesia, pain management, psychology, pharmacy, exercise medicine, physical therapy, occupational therapy, nutrition, and others. Learn more about the cancer and blood disorders program here.
Mai Songsawatwong