Genetic Marker to Help Children with T-Cell Leukemia Avoid Unnecessary Chemotherapy

About 400 children in the UK are diagnosed with acute lymphoblastic leukemia (ALL) each year, with roughly 15% presenting with a more aggressive T-ALL subtype. While the standard approach is a four-week course of chemotherapy, approximately 10% of patients show little or no response. However, clinicians currently have no way to predict which cases will resist treatment. This diagnostic gap exposes families to weeks of toxic therapy that may offer little benefit. New research has now identified a previously unrecognized cancer cell type that appears to drive this resistance, opening the door to tests that could prevent unnecessary chemotherapy and guide future targeted therapies.

In a collaborative study involving Cambridge University Hospitals (Cambridge, UK) and the Wellcome Sanger Institute (Hinxton, UK), researchers analyzed single-cell genomes from bone marrow samples of 58 children with T-ALL. They found that some children with T-ALL carry clusters of malignant T-cells that express a protein called ZBTB16. These cells did not respond to first-line chemotherapy and were present at diagnosis, suggesting they could serve as an early biomarker of poor treatment response.

The study, published in Nature Communications, showed that broader genomic analysis across hundreds of T-ALL cases confirmed that ZBTB16 can switch on at various stages of cancer evolution but consistently drives treatment resistance. Since existing diagnostic platforms can already detect ZBTB16, researchers believe the marker could be added to routine testing to identify high-risk patients on the day of diagnosis.

Detecting ZBTB16-positive cells early could help clinicians avoid ineffective treatment and prioritize alternative strategies. The researchers hope that targeting these newly identified resistant cells will eventually yield therapies for T-ALL cases that do not respond to current regimens. In time, this work may help transform care for children with aggressive leukemia, reducing unnecessary toxicity while advancing more effective, biologically informed treatments.

“Being able to identify children who have T-cell leukemia that will not respond to initial treatment on the day of their diagnosis has an immediate impact on their clinical care,” said Dr. David O’Connor, co-senior author. “While further clinical research is needed, the genetic marker we have discovered can also be identified using an already widely used test, meaning that it could be easily adopted into clinical care if proven effective.”

Related Links
Cambridge University Hospitals
Wellcome Sanger Institute