A groundbreaking clinical trial led by King's College London has demonstrated that a highly sensitive bone marrow test can detect the recurrence of Acute Myeloid Leukemia (AML) months before standard monitoring methods, potentially doubling survival rates for patients with this aggressive blood cancer.
The study, published in The Lancet Haematology, followed 637 patients in remission from AML between 2012 and 2018. Researchers found that regular bone marrow testing could identify traces of returning cancer up to three months earlier than conventional blood tests, providing a critical window for intervention.
Early Detection Creates Treatment Advantage
Around two-thirds of AML patients experience relapse months or even years after achieving remission, due to undetected leukemia cells remaining in the body. The new test detects specific RNA present in leukemia cells but absent in normal cells, allowing for intervention while patients are still clinically well.
"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," explained Dr. Richard Dillon, senior author and clinical senior lecturer at Cancer Genetics, King's College London.
The 10-minute procedure, performed under local anesthetic, involves inserting a hollow needle into the patient's hip bone to extract a sample every three months. This approach is particularly beneficial for patients with mutations in the NPM1 and FLT3 genes, which are common in younger AML patients.
Professor Nigel Russell, honorary consultant at Guy's and St Thomas' NHS Foundation Trust and chief investigator on the trial, highlighted the significance of the findings: "About one-third of patients really benefited from this approach, with a doubling of their survival, which was a massive improvement in outcome."
Patient Experience Confirms Life-Saving Potential
Jane Leahy, 51, from Wimbledon, credits the trial with saving her life. Diagnosed with AML in December 2014 at age 41, she went into remission following chemotherapy in April 2015. However, the trial's bone marrow testing detected abnormalities months later when her blood tests still showed remission.
"Without testing, I wouldn't have gone on to have my transplant, because my blood showed I was still in remission," Leahy explained. The early detection allowed her medical team to try alternative treatments when chemotherapy proved ineffective, ultimately leading to a successful stem cell transplant donated by her sister.
Nine years post-transplant, Leahy remains in remission. "It's pretty scary, really, when I think about potentially what could have happened," she reflected. "The time is always critical because it's so acute and so aggressive. And a lot of people die from AML before they get to treatment because it's just diagnosed so late."
Disease Burden and Clinical Context
AML causes the bone marrow to produce abnormal white blood cells that circulate throughout the body. Approximately 3,100 people are diagnosed with AML in the UK annually, with nearly half over 75 years old. However, the disease can affect anyone, including about 100 children under 19 diagnosed each year.
The disease has one of the lowest survival rates among cancers, with only 22% of patients surviving five years after diagnosis. Current standard monitoring involves regular blood tests, which often detect relapse only after patients become symptomatic and their condition has deteriorated significantly.
Implementation and Future Applications
The research team is now collaborating with the National Health Service to implement the test more broadly throughout the UK. They believe the procedure could potentially be adapted for diagnosing various other cancers as well.
Laura Challinor from Blood Cancer UK, which partially funded the study along with Cancer Research UK and the National Institute for Health and Care Research, noted that the findings "could help shift the dial in a positive direction." She added, "As this involves a bone marrow test every three months, we must also continue to push ahead with research into kinder therapies for the 280,000 people with blood cancer in the UK."
Dr. Dillon expressed 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."
The trial was sponsored by Cardiff University and represents a significant advancement in the management of one of the most challenging blood cancers, offering new hope to thousands of patients diagnosed with this aggressive disease.
