A highly sensitive bone marrow test could double survival rates for some groups of younger adults with Acute Myeloid Leukemia (AML) by helping doctors identify if they might relapse up to three months earlier.
The patient-specific molecular test can detect low levels of leukemia cells in the body, known as minimal residual disease (MRD), which when left untreated causes the disease to relapse.
The trial, published today in The Lancet Haematology and led by King's College London, showed for patients with mutations in the NPM1 and FLT3 genes – which are among the most common that cause AML in younger adults – that repeated molecular testing offered 50% better survival rates compared to usual care. Follow up clinical care usually involves regular blood tests and physical examinations.
Detecting these low levels of leukemia cells allows doctors to restart treatment quicker, when patients are well and their blood counts are normal, rather than at a later point when they have progressed to clinical relapse, which often has to be treated as an emergency.
The trial was funded by Blood Cancer UK, Cancer Research UK, the National Institute for Health and Care Research (NIHR) and was sponsored by Cardiff University.
The trial, which is the first of its kind, monitored 637 patients between 2012 – 2018 who were in remission from AML. Over three years patients either received the standard clinical monitoring, or additionally received regular molecular testing, with bone marrow tests every three months.
Acute Myeloid Leukemia is the most aggressive form of blood cancer, so knowing early that a patient's cancer is going to relapse is crucial for planning their treatment. We hope that these tests become part of routine care for this type of cancer across the UK and worldwide, and ultimately improve long-term survival rates for patients."
Dr. Richard Dillon, Senior Author and Clinical Senior Lecturer, Cancer Genetics, King's College London
The researchers have been working with the NHS to roll this testing out across the UK. The researchers say that there is potential for the method to be used on many other forms of cancer.
AML is an aggressive type of cancer which causes the bone marrow to produce abnormal white blood cells, which quickly spread around the body. It affects about around 3,100 people in the UK each year, including children. Patients who are in remission from AML following chemotherapy have a significant chance of the disease reoccurring, especially within the first two years after treatment finishes.
According to statistics from Cancer Research UK, cases of AML have increased by 12% in the UK since the 1990s.
Professor Nigel Russell, Honorary Consultant at Guy's and St Thomas' NHS Foundation Trust said: "There is still so much to learn about how best to treat this fast-moving form of cancer. We hope our research offers a new approach to detecting if a patient is at risk of relapse and offers hope to patients suffering from this disease."
Jane Leahy, a 51-year-old Business Process Owner from Wimbledon, took part in the trial from 2014 to 2018 where her AML relapse was detected at an extremely early stage. The test showed she was no longer responding to chemotherapy and provided the opportunity and time to try alternative treatment to get her back into remission ahead of a stem cell transplant.
She said: "Acute Myeloid Leukaemia is a horrific disease. Being enrolled on this trial saved my life and enabled doctors to try alternative treatments. It's amazing to see great progress being made in improving treatment options for patients. I hope that being part of this research is going to help save the lives of so many others who are in a similar position to me."
Professor Marian Knight, Scientific Director for NIHR Infrastructure and Director of NIHR Programme Grants for Applied Research said "Early detection of the potential for relapse of any cancer is essential to ensure people can restart or change treatment quicker and improve their long term survival rate. AML is an aggressive form of blood cancer and research like this is vital to help deliver the Government's mission to tackle the UK's biggest killers."
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