Research into childhood acute lymphoblastic leukaemia (ALL)
Researchers are looking into new treatments for acute lymphoblastic leukaemia as well as ways to reduce the side effects treatment can cause.
There are a number of clinical trials for children to join in the UK. And many children and young people with childhood leukaemia have their treatment as part of a clinical trial.
Individual trials close when enough people have joined. There might then be a period of time before the results are available. New trials then open based on what has been learned. Because of research, treatment for childhood ALL has got much better over the past 40 to 50 years. Now, more than 90 out of 100 children with ALL (more than 90%) survive.
This video shows how Cancer Research UK is involved in researching childhood leukaemia. It’s 1 minute and 30 seconds long.
Inside our bones is bone marrow and it’s where blood cells are formed from special cells called stem cells. Normally, these ‘blood factories’ pump out immature cells, which then mature into fully fledged red blood cells, white blood cells or platelets.
In acute leukaemia however, a fault occurs in these stem cells before we’re born, which means that the immature cells get stuck and never continue their journey to becoming useful cell types. This blockage in the system prevents the stem cells from doing their job.
Soon, this build up of problem cells spills out of the bone marrow and into the bloodstream, causing tumours to form in other parts of the body.
So, what causes the stem cells to produce these cancerous little blighters in the first place?
In most infant leukaemia, a translocation is responsible for the fault. This is when a section of one chromosome is switched with a section from another.
This change to the body’s chromosomes causes leukaemia but we don’t yet know exactly how it occurs.
Katrin Ottersbach, at the University of Edinburgh, is developing a way to study what happens, spot any markers of leukaemia earlier and crucially, allow us to test potential new treatments.
Across the country, Cancer Research UK is funding work like this, to better understand cancers affecting children and young people and to develop new, better and kinder treatments.
Alltogether-1
AllTogether-1 is a clinical trial developed on what we have learned from previous ALL research such as UKALL 2011. This trial is for those newly diagnosed with ALL from the ages of 1 to 45 years old (up to age 29 in the UK). It’s a large trial that includes several European countries. The overall aim is to improve survival and the quality of survival for children and young adults with ALL.
Alongside this trial researchers are also looking at how well ciprofloxacin works at preventing infections in children during the 
.
UKALL 2011
This was the largest clinical trial looking at ALL treatment in the UK. Doctors treat childhood ALL with chemotherapy. They use a number of drugs in different combinations. As with all treatments, there are side effects and doctors are always looking for ways to reduce them.
Researchers on this trial wanted to see if by changing the they could reduce the side effects of current leukaemia treatment. And if it reduces the chance of leukaemia coming back after treatment.
This trial has closed and we are waiting for the results. You can find out more detail about the trial and the results when they are available on our trials database.
Research into ALL that has come back or not gone away with treatment
ALL that has not gone away with treatment (refractory) or has come back after treatment (relapsed) is harder to treat.
Researchers are looking for new treatments for cancers including leukaemia when standard treatments stop working or don’t work.
They are looking at a few different combinations of treatment. Which treatment your child has depends on the found in the of their cancer.
They may have a combination of one or more of the following types of drugs:
targeted drugs immunotherapy chemotherapy
Other researchers are looking at a type of targeted cancer drug called carfilzomib. It’s a proteasome inhibitor.
Proteasomes are in cells. They help to break down proteins that the cell doesn't need. Carfilzomib blocks the proteasomes so the proteins build up inside the cell. The cell then dies.
Doctors have added carfilzomib to induction chemotherapy for relapsed or refractory ALL. The doctors want to find out:
- the best safe dose of carfilzomib to give
- what the side effects are
- how safe it is
- how well it works for children with relapsed or refractory ALL
- if it improves the number of children that get into
remission
Other targeted drugs being looked at include:
- ponatinib
- bortezomib
Immunotherapy using CAR T-cells
White blood cells called lymphocytes play an important part in fighting infection and diseases, including cancer. There are different types of lymphocytes. T cells are one type.
T cells move around the body to find and destroy defective cells. When you come into contact with a new infection or disease, the body makes T cells to fight that specific infection or disease. It then keeps some in reserve so that if you come across the infection again your body can recognise it and attack it immediately.
T cells are good at fighting infection. But it can be difficult for them to tell the difference between a cancer cell and a normal cell. So the cancer cells can hide away and not be recognised.
Scientists are trying to find ways to get T cells to recognise cancer cells. One possible way to do this might be CAR T-cell therapy.
CAR T-cell therapy is a very specialised treatment. A specialist team takes a sample of T cells from your child’s blood or a donor. This process is called apheresis.
In the laboratory the T cells are changed. You might hear this called genetically engineering the T cell. The T cell is now a CAR T-cell. CAR stands for chimeric antigen receptor. These CAR T-cells are designed to recognise and target specific proteins on the cancer cells.
These changed T cells grow and multiply in the laboratory. Once there are enough cells your child has a drip containing these cells back into their bloodstream. The aim is for the CAR T-cells to then recognise and attack the leukaemia cells.
Although CAR T-cell therapy is now used as a treatment for some children with a type of leukaemia called B cell ALL. Researchers continue to look at it in clinical trials for other types of ALL.
Research into stem cell transplants
Your child might have a stem cell transplant as part of their treatment for acute lymphoblastic leukaemia (ALL).
Having a transplant means destroying as many leukaemia cells as possible and replacing these with healthy .
Researchers in Manchester want to create new blood tests that can help predict if:
- acute graft versus host disease (aGvHD) is developing
- the leukaemia is coming back (relapse)
The researchers hope by developing this tests they can give medicines to prevent these problems from happening or treat them early on.
Research into longer term side effects
Researchers are also looking into the long term effects of treatment for all types of childhood cancer. The Centre for Childhood Survivor Studies is carrying out the British Childhood Cancer Survivor study.
This research is looking at children who were diagnosed with cancer between 1940 and 1991 and lived for at least 5 years after diagnosis.
This type of research takes many years to produce results because the children need to be followed throughout their lives. So, it will be some time before we know the results.
How to join a clinical trial
The best person to speak to about your child joining a clinical trial is their hospital consultant.
There might also be a research nurse at their primary treatment centre you can talk to. You could always chat through the options with your child’s clinical nurse specialist. They can help answer any questions you or your child might have.
For information about clinical trials you can also call the Cancer Research UK information nurses on freephone 0808 800 4040. They are available to help Monday to Friday, 9am to 5pm.
You can find more information about clinical trials for acute lymphoblastic leukaemia on our clinical trials database.
