International Consortium on Acute Leukemia

The International Consortium on Acute Leukemia (ICAL) is an international network that seeks to improve the care of patients with acute leukemia. This initiative, which is strongly supported by the American Society of Hematology (ASH), currently brings together clinical investigators from Europe, North America, and South America in the spirit of international clinical and laboratory collaboration.

While the initiative has been supported partly by ASH and partly by grants from the Umberto Veronesi Foundation, Roche, and Cephalon France, much of the activity is funded by local and national sources.

History of the Consortium

The consortium was founded in 2004 as the International Consortium on Acute Promyelocytic Leukemia (IC-APL). APL is a rapidly fatal subtype of acute myeloid leukemia and is now the most highly curable subtype when treated with contemporary therapeutic strategies.

As part of the IC-APL, four transitioning countries—Brazil, Mexico, Uruguay, and Chile—participated in a population-based registry study based on a standard-of-care protocol for APL and tailored to meet local resource considerations.

In Brazil, the results have been remarkable. The many positive outcomes include:

  • Improvements in the infrastructure necessary to conduct molecular diagnosis
  • Wide demographic enrollment through a participation requirement to incorporate public and private hospitals throughout the country
  • An establishment of a diagnostic baseline
  • Enhanced collaboration among researchers

In Uruguay, Chile, and Mexico, participation in the IC-APL has also markedly improved patient outcomes. According to co-chair Dr. Nancy Berliner, "Clinical outcomes rival those in large clinical trials in developed countries, with a complete remission (CR) rate of 90%, with most patients in CR having evidence of molecular remission."

Based on the initial success of the IC-APL, its governing body voted to expand the collaborative model to address other subtypes of acute leukemia, beginning with acute myeloid leukemia (AML). To reflect this change, the cooperative group is now called the International Consortium on Acute Leukemia (ICAL).

Current Focus

The initiative is currently focused on the development of a standardized treatment protocol for patients with low- or intermediate-risk AML. Although there are few studies regarding the outcome of AML in developing countries, existing data suggests fewer than 20 percent of AML patients are long-term survivors, due to delayed diagnosis, absence of methods for proper prognostic stratification, increased early mortality, and higher frequency of therapy-related complications.

ICAL currently includes Brazil, Chile, Paraguay, Peru, and Uruguay, and is likely to expand to other interested countries, which are chosen through a formal process. Countries need to demonstrate strong evidence of meeting the minimum requirements, which include the infrastructure necessary for diagnosis, treatment, and management of patients with acute leukemia.

Questions?

For more information on ICAL, including how to participate in this program, contact Michelle Lara, International Programs Specialist, mlara@hematology.org.