Improving treatment of acute leukaemia

Research conducted at UCL/UCLH over the last 20 years has enabled the identification of adults with acute leukaemia who are most likely to benefit from stem cell transplantation. Better patient selection results in improved survival, enhanced overall quality of life, and a more appropriate use of NHS resources.

Around 2,500 adults in the UK are diagnosed with acute leukaemia every year, and their treatment typically consists of intensive courses of chemotherapy. For some patients, further high-dose chemotherapy followed by stem cell transplantation may be of benefit, but this additional treatment is highly intensive, potentially toxic and expensive.

Researchers at the UCL Cancer Institute have collaborated with colleagues at Glasgow and Cardiff universities to examine the benefits of the additional transplantation treatments. Trials conducted from the 1990s onwards showed that only a subset of patients are likely to benefit, and that certain markers of genetic alteration in the leukaemia cells can be used to help identify these individuals.

This risk classification has now been adopted globally, and helps to avoid the unnecessary use of stem cell transplantation in adults with lower risk acute leukaemia, which has a good chance of being cured with chemotherapy alone - in the UK this amounts to around 400 patients per year, and many thousands worldwide. The cost savings to the NHS are considerable - the avoidance of 400 stem cell transplants is a potential saving of about £28m per annum. More importantly, patients avoid the not-insignificant risks of treatment-related mortality and impaired quality of life which may result from the complications of transplantation.