THE MONTREAL BIOBANK NETWORK FOR PEDIATRIC AND YOUNG ADULT LEUKEMIA
Hematologic Cancers in Children and Youth
Leukemia is the most common childhood cancer in Canada, accounting for 26% of new cases and 28% of deaths due to cancer in children. Lymphomas, the second most common group of childhood cancers, constituted 18% of new cases and 8% of deaths (the National Cancer Institute of Canada, Cancer statistics 2008).
Despite the tremendous success in the treatment of acute lymphoblastic leukemia (ALL) in children, with ~80% of cases being cured, leukemia remains a significant health problem and several issues remain to be addressed:
1. The etiology of leukemia in children, adolescents and adults is unknown and the mechanisms leading to leukemia are not well understood. It is imperative that we improve our knowledge of the underlying causes of leukemia to develop novel and less toxic therapies.
2. The remaining 20% of patients with ALL is non-responsive to current treatments and we need innovative drugs for these patients.
3. There is an urgent need for more targeted therapies in this young age population. A significant proportion of patients who are cured will have life-long adverse effects related to cancer or its treatment, including long-term growth problems, learning difficulties, sterility, and a high risk of developing secondary cancers later on in life. New strategies are required to reduce acute and long-term toxicities. Development of these new strategies can involve three major avenues of research:
- Assess the role of genetic variation to environmental agents in the modulation of disease susceptibility,
- Use modern tools of molecular dissection such as DNA expression arrays and proteomics to develop therapy that specifically target the leukemia cells
- To assess the genetic variation of individuals in the metabolism of chemotherapeutic agents (pharmacogenomics) in order to tailor dosing rather than take a “one size fits all” approach. In doing this one can decrease toxicity and maximize the therapeutic index.
4. Adolescents and young adults represent a minority of patients enrolled in adult or pediatric clinical trials and the appropriate treatment regimen for this group of patients is not well defined.
Major decrements in survival start above 15 years of age and in contrast to children, current adult treatment regimens result in 5 years survival of less than 40%.
5. Acute myelogenous leukemia (AML) accounting for ~20% of acute leukemias in children, has posed significant therapeutic challenges and despite intensive therapy, half of the children with AML will relapse and die from their disease.