Only a few researchers worldwide could lead the kind of study Lillian Sung is now conducting with her Canadian Cancer Society funding.
After many years of study, Dr Sung’s qualifications are extraordinary. She’s a clinician and scientist, a pediatric oncologist and infectious diseases specialist. And she has a PhD in clinical epidemiology.
All of these skills are key to her study of potentially fatal infections in children with acute myelogenous leukemia (AML). “It’s a somewhat neglected area yet very important in terms of its impact on a child’s quality of life and quantity of life,” says Dr Sung, who works at Toronto’s Hospital for Sick Children.
AML is an aggressive cancer and only 50% to 60% of children will survive. “Consequently, the chemotherapy is among the most intense we give to any child with cancer. We essentially hospitalize the child for the entire duration of therapy, which is about 6 months.”
During those 6 months, children become vulnerable to infection, which can mean high fevers, organ complications, trips to intensive care units and even death. Up to 20% of deaths from AML are caused by infection rather than the cancer itself.
Doctors don’t know why some children are more vulnerable than others. Dr Sung believes the answer is in their genes. Her Society-funded study will look for genetic markers that can identify children at greatest risk of infection. Those children could then be given preventative treatments such as antibiotics.
“We could target our interventions, minimize complications and hopefully improve survival,” says Dr Sung.
To complete the study, she needs to collect DNA samples from 300 children. Because AML is relatively rare, she’s approached institutions across North America. Fourteen Canadian pediatric oncology centers, and 2 in the United States, are now enrolling patients.
“We’ve enrolled about 150 patients so we’re halfway through. We have a very low refusal rate. Parents seem to think this is a very important study and have been very enthusiastic.”
Dr Sung is also reaching out to collaborators in Central America, where infection-related deaths are a major concern for children with many cancers. “We are really hoping to translate our findings into the developing world and use the lessons we learn here to help improve outcomes there. It’s a very exciting part of our research program.”