St. Jude Children's Research Hospital

Our mission is to find cures and save children with cancer and other catastrophic disease through research and treatment. We have treated children from all 50 states and from around the world. No family ever pays St. Jude for anything.
Jun 4, 2015

Measuring treatment response proves powerful

Dr. Pui
Dr. Pui

St. Jude Children’s Research Hospital investigators report that measuring leukemia cells that persist in patient bone marrow in the early weeks of treatment helps identify high-risk patients who need intensive therapy.

Measuring the concentration of leukemia cells in patient bone marrow during the first 46 days of chemotherapy should help boost survival of young leukemia patients by better matching patients with the right intensity of chemotherapy. St. Jude Children’s Research Hospital investigators led the research, which appears in the March 20 edition of the journal Lancet Oncology.

The findings stem from a study of 498 children and adolescents with acute lymphoblastic leukemia (ALL) enrolled in a St. Jude-led protocol between 2000 and 2007. The clinical trial was the first to use measurement of residual leukemia cells – or minimal residual disease (MRD) – in bone marrow to help guide therapy. St. Jude pioneered MRD measurement as a tool to guide leukemia treatment.

“This analysis shows that MRD-directed therapy clearly contributed to the unprecedented high rates of long-term survival that patients in this study achieved,” said first and corresponding author Ching-Hon Pui, M.D., chair of the St.Jude Department of Oncology. Overall, 93.5 percent of patients were alive five years after their cancer was diagnosed. “MRD proved to be a powerful way to identify high-risk patients who needed more intensive therapy and helped us avoid over-treatment of low-risk patients by reducing their exposure to chemotherapy,” Pui said.

Researchers hope the findings will expand use of MRD measurements to guide leukemia treatment in children and adults.

The technique might also help identify patients who could be cured with less intensive chemotherapy, Pui said. Overall long-term survival was 97.9 percent or better for 244 patients in this study classified as low risk based on a variety of factors including their age at diagnosis and MRD of less than 1 percent on day 19 of treatment. “Given the excellent outcome, it will be important to determine if treatment can be further reduced in this subgroup of patients,” Pui said.

In countries with limited resources, Pui said the findings suggest that results of MRD on day 19 can be used to reduce treatment-related deaths by identifying patients who will likely be cured with low-intensity chemotherapy. “This study demonstrates these patients have an extremely low risk of relapse,” he said.

The study showed that measuring MRD just twice during remission induction therapy – at day 19 and day 46 – rather than multiple times during the more than two years of treatment was sufficient to guide treatment of most pediatric ALL patients. That will help save money and protect patients from the discomfort and risks associated with bone marrow aspiration for MRD testing. MRD measurements should continue, however, to guide treatment of patients with detectable MRD on day 46 of treatment. That is a level of 0.01 percent or more, which translates into one leukemia cell in 10,000 normal cells.

MRD was not a perfect predictor of relapse risk. Cancer returned in 26 of the 430 patients with undetectable MRD when treatment ended after 120 weeks. Researchers are working to develop even more sensitive methods for tracking treatment response in order to identify those at risk for having their cancer return.

Overall, researchers showed that regardless of other risk factors, including age at diagnosis or the initial white blood cell count, patients with an MRD level of 1 percent or more on day 19 of therapy were far less likely than other young leukemia patients to be alive and cancer-free 10 years later. Having detectable leukemia cells on day 46 of treatment was also associated with lower survival.

MRD levels on days 19 and 46 led to the reclassification of 50 patients from low risk to a higher risk leukemia that warranted more intensive therapy. Researchers credited the change with boosting survival.

The other authors are Deqing Pei, Sima Jeha, Cheng Cheng, John Sandlund, Raul Ribeiro, Jeffrey Rubnitz, Hiroto Inaba, Deepa Bhojwani, Tanja Gruber, Wing Leung, James R. Downing, William Evans and Mary Relling, all of St. Jude; Elaine Coustan-Smith and Dario Campana, both of the National University of Singapore; and W. Paul Bowman, of the University of North Texas Health Sciences Center, Fort Worth, Texas.

The research was funded in part by grants (CA21765, CA36401, GM92666) from the National Institutes of Health and ALSAC.

Mar 2, 2015

Committed to Jamill (St. Jude)

St. Jude Patient, Jamill
St. Jude Patient, Jamill

St. Jude wants to make sure that Jamill keeps a smile on his face. 

Jamill’s mom describes him as mellow and sweet. This 4-year-old loves riding his bike and going to basketball games. The first few years of his life have been difficult due to sickle cell disease, but St. Jude Children’s Research Hospital has been there every step of the way to ease his pain and keep him as healthy as possible.

When Jamill was born, tests revealed he suffered from sickle beta thalassemia disease, a subtype of sickle cell disease. Sickle cell disease is a genetic blood disorder that affects the hemoglobin within the red blood cells, causing the cells to become hard and form a sickle shape. The sickle shaped cells can cause pain, organ damage or stroke.

St. Jude has a deep and longstanding commitment to children with sickle cell disease. Scientists at the hospital have been researching the disease since the institution opened in 1962. With more than 750 patients in its sickle cell program, St. Jude remains one of the leaders in the crusade to spare children the suffering this chronic disease causes.

Little Jamill has experienced pain crises and high fevers associated with sickle cell disease, often needing to be hospitalized for days at a time. “As soon as I call and let St. Jude know we are on the way, they get Jamill’s room ready,” said his mom, Tanshika. “I know they are taking really good care of him.”

Jamill’s treatment at St. Jude includes daily penicillin and any additional care he might need to manage symptoms of the disease. He visits St. Jude every three months for routine checkups.

“Jamill’s pain crises have occurred less often as he gets older and continues treatment,” Tanshika explained. “I really like everyone at St. Jude. We’ve always been well taken care of thanks to the doctors and all of the staff.”

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Nov 19, 2014

Healing Harmony

Music Therapist Amy holds a session with patients
Music Therapist Amy holds a session with patients

At St. Jude, music therapy empowers children, helping them meet developmental goals while providing an outlet for expression.

With an elfin grin, Kyle approaches the piano, eager to tickle the ivories in preparation for his first recital.

Nervous?

“Oh, no!” he declares, dismissing the question with a quick shake of the head and flip of the hand.

“Him?” his mother, Chasity, teases. “He loves the attention.”

Weeks before the musical event in a St. Jude auditorium—invitation only, and everybody who knows and loves Kyle is invited—he is rehearsing his selections and preparing his wardrobe.

“He has a new blue shirt and tie,” announces his mom, eyes twinkling.

“And…tell what kind,” he prompts her.

“A big-boy tie; no clip-on.”

“Yep, that’s right!” he affirms, delighted.

At 7, Kyle possesses the confidence and tolerance he needs to take on not only the keyboard, but also the cancer treatment he’s undergoing at St. Jude Children’s Research Hospital.

He arrived in February from Louisiana and, to him, it was important to continue his music. Kyle had begun piano lessons in October 2013 and had started memorizing recital pieces.

But cancer interrupted the plan.

“He was upset,” Chasity says, “because he would miss his spring recital.”

When Kyle arrived at St. Jude, he met music therapist Amy. Kyle told her of his appreciation for piano; she immediately added an electronic keyboard to her collection of instruments. The more Kyle listened and learned and practiced, the more he hoped for a recital.


Hitting the right note

“Music is therapeutic,” Love explains. “Research shows that music is the only thing that lights up all of our brain at once. For kids like Kyle, music helps build fine motor skills, improves concentration and task orientation, and assists with reading and learning a language.

And music gives Kyle something to celebrate,” Love adds.

Kyle is being treated for a rare combination of germ cell tumors: germinoma and embryonal carcinoma. As part of his treatment, Kyle has undergone brain surgery, spinal surgery, chemotherapy and radiation therapy.

“He’s had minimal sickness. Chemo hasn’t slowed him down one little bit,” his mom reports, “but he did get upset thinking he was going to have to miss a year’s worth of piano.”

“I had already picked my song, ‘Swans on the Lake,’ for my recital,” Kyle adds.

“So they came up with the idea of a recital here,” Watson says. “While we’re in Memphis, Kyle particularly looks forward to seeing Miss Amy every week.”

Rhyme, rhythm and song

Kyle is not the only patient who has fallen for Amy. She makes her rounds, guitar strapped to her back, pushcart in tow, piled with drums and ukuleles; little xylophones and jingly bells on bracelets; even a cylinder that, when shaken, sounds like a thunderstorm. Amy’s ever-present electronic tablet contains song lists.

As she passes through the corridors, children grin, parents nod and, by the dozens, she calls them by name.

Entering a patient’s room, she greets a dour little face and gently announces, “I’m glad to be with you today, and I’m really glad for all the music we will play.”

A silent boy reaches out a slim arm for the drum she holds, the mallets and noisemakers she offers.

“Which song would you like today?”


Voices and choices

Amy says she enjoys offering choices to children who may not feel that they have control over other aspects of their life.

“Music is a way of releasing a lot of tension in your body. People sing at weddings, funerals, graduations, on the radio, so why not in the hospital? You should have access to ways to express yourself—a music voice,” Amy says.

The boy in the bed chooses the drum, the song, and, as it turns out, the meter.

“Kids aren’t always feeling well, but sometimes they have a lot of energy they have to get out of their bodies,” Amy says.

As she sings, the boy beats out the rhythm—moderate, then slow; fast, then ridiculously fast; ridiculously slow, and back and forth. The patient grins at his own mischief with music. And the two musicians laugh together.


Heart, mind, spirit

“Sometimes we use music therapy to promote physical goals,” Amy explains. “You can use a steady pulse of music as a rhythmic cue for walking a specific pace or for learning a certain phrase with intonation, because the neuro-pathway for music is different than the one for speech.

“I may go into a patient’s room and the child is anxious,” Amy continues. “I match the tempo of my guitar picking to the child’s heart rate. As I slow the tempo, the child’s oxygen saturation may increase and the blood pressure may decrease.”

Music, she says, also has a place in legacy building.

“We’re rolling out heartbeat therapy,” Amy says. “We can put a microphone in a stethoscope, record the child’s heartbeat and create and perform a song over it, making that heartbeat into a beautiful memory.”

At regular sing- and play-a-longs in the Kay Kafe lobby for kids and adults who happen by, Amy is prepared when a little girl begins to cry: Another child has the instrument she wants. Amy pulls out jingly bell bracelets, and harmony is restored.

Harmony of spirit. Harmony of sound. Budding pianist Kyle understands.

“I love all the harmonies,” Kyle says. “When I watch a movie or listen to music, I notice the harmonies. I notice when the singing starts. I can pick out the instruments, especially the piano.

“You know, I’m having a recital in the auditorium. Would you like to come? I’m playing three songs: ‘Swans on the Lake,’ ‘Jesus Loves Me’ and ‘Let It Go.’ I can’t wait.”

What is music therapy?
A clinical and evidence-based practice, music therapy can be used to achieve both musical and non-musical goals. One musical goal for a patient such as Kyle might be learning to play piano. A non-musical goal might be using drums to improve motor skills. Music therapist Amy also helps patients attain emotional goals, such as learning to express themselves by writing and performing songs and discussing song lyrics. Creativity also helps patients cope with disease and its treatment.

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