Understanding how some leukaemia cells survive treatment and cause a relapse

Childhood acute lymphoblastic leukaemia (ALL) is the most common childhood cancer. Whilst cure rates are generally good, for those children who relapse from their disease, the chance of a cure becomes much poorer. To help improve survival for this group of leukaemia patients, Professor Irving’s study will conduct research to improve our understanding about how some leukaemia cells are able to survive initial treatment and cause a patient to relapse.

Research analysis on the DNA of leukaemia cells have indicated that they are genetically different in a patient at relapse compared to the bulk of these cells at their diagnosis. However, we also think that they were already present at this point in very small amounts. During the early stages of treatment, the bulk of leukaemia is sensitive to the chemotherapy and is killed off, while the cells that have the capacity to emerge as relapse, survive.

These ‘hardy’ leukaemia cells that evade the chemotherapy are known as residual disease. Professor Irving’s project has a unique opportunity to genetically ‘track’ the relapsed leukaemia in bone marrow samples taken at diagnosis and more uniquely during treatment when there are high levels of residual disease.

The study will use sensitive DNA sequencing and focus on searching for genetic markers in relapsed patients that indicate sensitivity to new ‘magic bullet’ drugs. Findings from this project can help to answer whether ‘magic bullet’ drugs aimed specifically at the residual chemotherapy-resistant leukaemia may be a way to prevent relapse and help more children with ALL to survive.