Debunking myths
Daniel DeAngelo (left) and Lewis Silverman are studying patients ages 1-51 to see at which point biological differences may affect treatment.
We have devised a study here in which we're looking at people ages 1-51. We're treating common biology commonly by taking leukemia cells and testing all of them the exact same way. I call this "Age Unrestricted Biology-Based Research." We have 17 adult treatment sites and nine pediatric sites reporting to us, with my Dana-Farber physician colleagues Dan DeAngelo running the adult group and Lewis Silverman the pediatric group.
For most pediatric patients with ALL, we've found in the past that if they can handle 26-30 weekly doses of asparaginase, our cure rate is 90 percent. In our preliminary study of adults, we tried to give the desired 30 doses of asparaginase to 80 patients who were age 18-50. Lo and behold, the same percentage of adults tolerated this intensive treatment, as did older children in the pediatric study. The early results suggest that cure rates for adults will be much better than in the past, hopefully comparable to those of the older children. Our larger study hopes to build on these results; I believe we are on our way to debunking the asparaginase myth, and hopefully curing more patients.
This much we know: If you are under 21 and you have ALL, you should be on a pediatric-type protocol. All the studies show it is going to double your chances of being alive. What we don't know about is the rest of the population. Is there something fundamentally different about our biological makeup when we're 30 or 40 or 50 that's different from when we're 10 or 20? Is there something different about the leukemia cell? Is there something different about the treatment regimen? Finally, is there something about being a pediatrician or an internist that is fundamentally different in either who we are or how we practice? That's a big mystery, and a key reason why our study covers people up to age 51.
At the end of five years, we hope to have the answers to all of these questions.
