Completion of leukaemia trials

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Forty years ago almost nobody was cured of leukaemia. Nowadays, however, in countries such as the UK most children and young adults who develop the disease are completely cured, and they and their descendants will probably have no adverse late effects from it or its treatment. Although complete cure is less common among older leukaemia patients it is sometimes achieved, and even if the disease cannot be cured, prolonged remission with a good quality of life may nowadays be possible. Most of this progress has involved not huge breakthroughs that could easily be recognised as such, but a series of gradual improvements, each too small to be recognised reliably without large randomised trials in which half the patients got one treatment, half got another, and both groups of patients were then followed up for many years. Indeed, some moderate improvements in treatment could be reliably recognised as such only when there was worldwide collaboration between all who had ever conducted such a randomised trial of it. For many years the CTSU has coordinated nationwide UK leukaemia trials and the present application is to allow us to continue our involvement over the next 4 years. Leukaemia trials take far more than 4 years to complete, however, so the main results emerging over the next 4 years will be from trials that are already in progress among many hundreds, or even thousands, of patients, and from worldwide collaborations that the CTSU has already partly established, involving thousands or even tens of thousands of patients. Some of these studies, helped by the new genetic and other tests that are now becoming possible on the many thousands of stored samples from current and past MRC leukaemia trials, will probably show that some particular types of patient will gain net long-term benefit from more intensive treatment, and that other patients will not. Clear results from the CTSU can quickly change clinical practice, and could well save both lives and money.