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Chemotherapy drugs can induce mutations that lead to relapse in pediatric ALL patients Chemotherapy has helped make acute lymphoblastic leukemia (ALL) one of the most survivable childhood cancers. Now, researchers working in the U.S., Germany and China have shown how chemotherapy drugs called thiopurines can lead to mutations that set patients up for relapse. The work appears today in the journal Nature Cancer. The research provides the first direct genomic and experimental evidence in pediatric cancer that drug-resistant mutations can be induced by chemotherapy and are not always present at diagnosis. The findings offer a paradigm shift in understanding how drug resistance develops. The results also suggest possible treatment strategies for ALL patients who relapse, including screening to identify those who should avoid additional thiopurine treatment.

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