PRECISION‑CSF: A new test to help personalise treatment for children with leukaemia

The challenge

Children, teenagers and young adults with acute lymphoblastic leukaemia (ALL) need many injections of chemotherapy into the cerebrospinal fluid (CSF) – the fluid around the brain and spine – to stop the cancer coming back in the brain after treatment. While this saves lives, the injections can also cause side effects, including long‑term problems with learning and memory. Doctors want to be able to give each child exactly the right amount of brain-directed treatment – not too much and not too little. However, they do not have accurate tests to measure how much leukaemia is present in the brain and how it is responding to treatment. 

Hospitals can use a technique called flow cytometry to look for tiny numbers of leukaemia cells in CSF. This method is much more accurate than traditional microscope‑based tests. However, there is a major challenge: leukaemia cells in CSF die very quickly once the sample has been taken. Even short delays before testing can make it look as though fewer cancer cells are present than there really are. This makes the results unreliable and difficult to compare across different hospitals.

The project

In this project, Professor Christina Halsey is working on a way to stabilise leukaemia cells in the CSF. Her team at the University of Glasgow have already discovered why these cells die so rapidly - the CSF doesn’t have the essential nutrients that leukaemia cells normally get from the blood. Her team has found that adding these nutrients back into the CSF can keep these cells alive for much longer in the lab. 

Now, the researchers hope to use this understanding to create a stabilisation fluid that can be added to CSF samples immediately after they are taken. This would protect leukaemia cells long enough for accurate testing, even if samples need to be transported to specialised labs. Prof Halsey’s team will test a wide range of chemicals and nutrients to find the best combination to keep cells alive and will then make sure that the CSF can still be tested with flow cytometry. 

The impact

If successful, this project could lead to the first reliable way to stabilise CSF samples for leukaemia testing. This could have a global impact, ensuring that children everywhere receive more accurate diagnoses and better-tailored treatments.