University of Virginia Library

Medical Center Finds Test
May Help Detect Leukemia

A research study at the University
Medical Center indicates
that a test not previously related to
the medical control of cancer may
lead to easier recognition of stages
of childhood leukemia.

Dr. Milton H. Donaldson, assistant
professor of pediatrics and
surgery at the University, described
his findings Saturday in Atlantic
City, N.J., at a meeting of the
Society of Pediatric Research.

The year-long study checked the
level of a normal metabolic byproduct
of purines excreted in the
urine. Purines are protein building
blocks of cells. The by-product,
known as AIC, is found in significantly
higher levels in leukemic
patients, especially those in relapse.

The test used to check the AIC
level requires a 24-hour collection
of urine, with a portion tested
chemically to determine the
among of AIC excreted in the
24-hour period. The test was first
reported in 1961 by a Canadian
husband-wife research team, but
Dr. Donaldson's study of 10 normal
and 10 leukemic children is more
extensive than their preliminary
report.

Correlating the AIC test results
with the diagnosis established by
bone marrow tests, Dr. Donaldson
found only nine percent error in
the AIC test's diagnostic value. The
bone marrow test indicates the
stage of the disease through a blast
or leukemic cell count.

"Many laboratory tests have a
much higher rate of error and are
still usable," Dr. Donaldson said.

Dr. Donaldson noted that the
AIC test may also have value as a
predictor.

"It may be accurate enough to
predict that the child is going into
relapse before the change can be
detected in the bone marrow and it
may indicate toxicity to a drug," he
said.

"In this case, we could change
to an effective drug earlier and
possibly maintain the state of
remission longer," he said.

The University study also indicates
that the AIC test is invalid for
patients on drugs which interfere
with folic acid metabolism, such as
methotrexate, often used to treat
acute leukemia. The AIC level
proved consistently higher in
patients taking those drugs, regardless
of the stage of the disease.

Dr. Donaldson cites physical,
economic and psychological advantages
of the AIC level test over the
bone marrow test in which a needle
must penetrate to the bone marrow
itself.

"The bone marrow test can be
quite painful, besides subjecting
both the child and his parents to
greater psychological anxiety," he
said.

He also notes the test can reduce
such patient expenses as travel since
the specimens can be mailed in,
alleviating the need for the patient
to by physically present for the
AIC test.

The University study grew out
of a summer research project
started by then University of
Virginia medical student Gary
Lulenski, now a surgical intern at
the University of Chicago Clinics.
Dr. David S. Newcomb, former
University of Virginia medical
professor, now associate professor
of medicine at the University of
Vermont, also assisted in the study.

Dr. Donaldson plans to continue
the study of the test at the
University, having patients mail in
specimens.

"If the AIC level rises, we can
bring the patient into the hospital
for a bone marrow test earlier and
see if we can prove that we have
detected a relapse even before it is
detectable by a microscopic study
of the marrow," he dais.

This continuing study will be
supported in part by a grant from
the Virginia Division of the
American Cancer Society.