Dr. David Teachey
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During residency, David Teachey, MD, met two physicians who impressed upon him the need to study childhood cancer at the bench, so better care could be delivered at the bedside. It didn’t take him long to dedicate his career to pediatric cancer. Today, he leads the COG’s acute lymphoblastic leukemia (ALL) committee. Meet Dr. Teachey and read about how ALL researchers are taking on the most common childhood cancer at every level.
PHOTOS COURTESY OF DR. DAVID TEACHEY
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David Teachey, MD, loves pediatric oncology because he gets to take care of the whole patient and their family. He's been practicing at the Children’s Hospital of Philadelphia for nearly 25 years and has seen significant improvements in care. He also describes himself as "a little impatient, because he wants to get new treatments to patients as quickly as possible."
As the chair of the COG’s acute lymphoblastic leukemia (ALL) committee, he does everything he can to remove barriers to research and ensure his committee members have the space and resources to collaborate.
“One of the best things about our ALL committee is that we’re dedicated to understanding and studying how the biological and care factors impact the whole patient,” Dr. Teachey says. “We’ve made some big discoveries in the last few decades, but there’s a lot more work left to do.”
We asked Dr. Teachey to fill us in on some of the most recent ALL breakthroughs and why a comprehensive research approach is the key to meaningful progress.
As the chair of the COG’s acute lymphoblastic leukemia (ALL) committee, he does everything he can to remove barriers to research and ensure his committee members have the space and resources to collaborate.
“One of the best things about our ALL committee is that we’re dedicated to understanding and studying how the biological and care factors impact the whole patient,” Dr. Teachey says. “We’ve made some big discoveries in the last few decades, but there’s a lot more work left to do.”
We asked Dr. Teachey to fill us in on some of the most recent ALL breakthroughs and why a comprehensive research approach is the key to meaningful progress.
ALL is the most common childhood cancer – where does it start and what causes it?
ALL is a cancer of white blood cells, which are an important part of our immune system that help us fight infections. These cells develop in the bone marrow. ALL happens when the white blood cells don’t grow into mature cells like they’re supposed to. When those immature cells start to multiply and move beyond the bone marrow into the rest of the body, they crowd out healthy cells. When that happens, we call that leukemia.
There are two main types of ALL: B-cell ALL which is the most common type and T-cell ALL which is relatively rare.
ALL is a cancer of white blood cells, which are an important part of our immune system that help us fight infections. These cells develop in the bone marrow. ALL happens when the white blood cells don’t grow into mature cells like they’re supposed to. When those immature cells start to multiply and move beyond the bone marrow into the rest of the body, they crowd out healthy cells. When that happens, we call that leukemia.
There are two main types of ALL: B-cell ALL which is the most common type and T-cell ALL which is relatively rare.
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You study high-risk T-cell ALL. Can you tell us why treating this type of cancer is so complex?
Lots of factors determine if a child has standard-risk or high-risk ALL. We consider the child’s age and how many abnormal white blood cells they have circulating in the blood. If a child has T-cell ALL, a white blood count of above 50,000 or certain genetic abnormalities in the cancer cells, it’s likely they’ll have a high-risk diagnosis. My research focuses on T-cell ALL and T-cell lymphoma. I take a bench to bedside and back approach. One area I study is called “risk stratification”, which is focused on analyzing several pieces of a patients’ biology to help us figure out the right treatment for them. In my lab, we also focus on testing new targeted therapies, which are drugs that act like magic bullets to attack the inner workings of leukemia cells; closely related to this testing is actually developing new immune therapies. Another equally important area of research I do is understanding what social determinants of health have an impact on the outcomes of T-ALL patients. |
Dr. Teachey and the researchers in his lab take a respite.
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I have the great fortune of working with so many smart and dedicated colleagues. This includes many talented scientists in my own lab, but also brilliant physicians and scientists in North America and across the globe.
One of the biggest breakthroughs for ALL has been the development of immunotherapy. Can you tell us more about it and why it’s important?
Immunotherapies help the healthy immune cells identify the cancer cells, and instruct them to attack them – just like they would attack the flu. Many patients who receive immunotherapy experience more mild side effects than they have with chemotherapy.
One of the most exciting immunotherapies for ALL is Chimeric Antigen Receptor (CAR) T cell therapy. CAR T cell therapy involves taking some of a patient’s white blood cells from their body and genetically engineering them to have one specific goal – find and destroy cancer cells. In a lab, those new cells are multiplied by the millions and put back into a patient's body. Once the new T-cells find a cancer cell and destroy it, they set out to search for new ones.
Blinatumomab is another exciting immunotherapy used to treat ALL. Several COG trials have studied the effectiveness of blinatumomab in patients whose cancer has relapsed. But in July 2024, a COG clinical trial (AALL1731) that included blinatumomab into standard treatment plans for newly diagnosed patients closed early because it was shown to greatly reduce relapse rates. Now it’s become part of standard care for most B-cell ALL patients.
While we’ve made big strides in immunotherapy for B-cell ALL, developing an immunotherapy for T-cell ALL has proved to be very difficult. Keith August, MD with Children’s Mercy and Eric Schafer, MD with Texas Children’s will lead the next immunotherapy trial (AALL2331) for T-ALL patients and I’m hopeful we’ll make important progress.
Immunotherapies help the healthy immune cells identify the cancer cells, and instruct them to attack them – just like they would attack the flu. Many patients who receive immunotherapy experience more mild side effects than they have with chemotherapy.
One of the most exciting immunotherapies for ALL is Chimeric Antigen Receptor (CAR) T cell therapy. CAR T cell therapy involves taking some of a patient’s white blood cells from their body and genetically engineering them to have one specific goal – find and destroy cancer cells. In a lab, those new cells are multiplied by the millions and put back into a patient's body. Once the new T-cells find a cancer cell and destroy it, they set out to search for new ones.
Blinatumomab is another exciting immunotherapy used to treat ALL. Several COG trials have studied the effectiveness of blinatumomab in patients whose cancer has relapsed. But in July 2024, a COG clinical trial (AALL1731) that included blinatumomab into standard treatment plans for newly diagnosed patients closed early because it was shown to greatly reduce relapse rates. Now it’s become part of standard care for most B-cell ALL patients.
While we’ve made big strides in immunotherapy for B-cell ALL, developing an immunotherapy for T-cell ALL has proved to be very difficult. Keith August, MD with Children’s Mercy and Eric Schafer, MD with Texas Children’s will lead the next immunotherapy trial (AALL2331) for T-ALL patients and I’m hopeful we’ll make important progress.
What about the blinatumomab study outcomes are most exciting for ALL patients?
In 2019, Rachel Rau, MD with Seattle Children’s and Sumit Gupta, MD, PhD, with SickKids opened the AALL1731 clinical trial that put blinatumomab into patients’ initial treatment plan. We were all hopeful it would help lower the relapse rate. But we were shocked to see the initial data that blinatumomab increased the success rate from 88% to 96%. Rarely does a new therapy have this big of an impact on reducing relapse rates in any cancer.
Now nearly every child who is diagnosed with B-cell ALL will receive this therapy and I’m hopeful we will maintain a much lower relapse rate.
In 2019, Rachel Rau, MD with Seattle Children’s and Sumit Gupta, MD, PhD, with SickKids opened the AALL1731 clinical trial that put blinatumomab into patients’ initial treatment plan. We were all hopeful it would help lower the relapse rate. But we were shocked to see the initial data that blinatumomab increased the success rate from 88% to 96%. Rarely does a new therapy have this big of an impact on reducing relapse rates in any cancer.
Now nearly every child who is diagnosed with B-cell ALL will receive this therapy and I’m hopeful we will maintain a much lower relapse rate.
Making an immunotherapy part of standard treatment plans is a huge win for ALL patients. Why is it also a win for children with other types of cancers?
We've been able to do a lot of research on ALL because it’s the most common childhood cancer. For example, CAR T cell therapies were developed for ALL. Researchers around COG studied how it worked and what its challenges were. Now we have CAR T cell therapies for central nervous system cancers and sarcomas. I look forward to seeing how blinatumomab can help advance new treatments in the same way CAR T therapies have.
We've been able to do a lot of research on ALL because it’s the most common childhood cancer. For example, CAR T cell therapies were developed for ALL. Researchers around COG studied how it worked and what its challenges were. Now we have CAR T cell therapies for central nervous system cancers and sarcomas. I look forward to seeing how blinatumomab can help advance new treatments in the same way CAR T therapies have.
Can you share more about the survivorship research your committee is working on?
One of the wonderful things about COG is that we’ve made it a priority to minimize the long-term side effects of cancer. Smita Bhatia, MD, MPH with Children’s of Alabama has dedicated much of her career to investigating survivorship and the impact of adherence in children with ALL. Her research has helped us understand that kids from disadvantaged neighbors often have a higher risk of developing later health complications and how the age a child is diagnosed also plays a role in their long-term health outcomes.
Both Sarah Alexander, MD with SickKids in Toronto and Lisa Jacola, PhD with St. Jude are leading research to understand how anesthesia and chemotherapies impact a child’s cognitive skills. Many end up having a difficult time concentrating or comprehending what they’re learning. We’re all looking forward to learnings from Lamia Barkat, PhD who works with me at CHOP, and is researching psychosocial risk and resilience in children with cancer.
We also have researchers studying how cancer treatment impacts a child’s physical body. Nina Kadan-Lottick, MD with Georgetown University is studying how improving mobility through exercise can help with long-term health in children with ALL. Elena Ladas, PhD at Columbia University is studying the impact of malnutrition and obesity on short and long-term outcomes in children with ALL.
What is the one thing you want everyone to know about COG?
What’s special about COG is that with every new therapy or patient experience study, we involve experts from all areas of cancer research. From each study, we’re going to learn about the biology of leukemia, the toxicity of treatments, and how things like socioeconomic factors impact outcomes.
I’d like to offer a second thing I want everyone to know – we can only move forward if we have more funding across basic sciences, translational science and clinical science. This includes studying the genetics of cancer and the genetics of our patients. A holistic approach will be the key to more breakthroughs.
One of the wonderful things about COG is that we’ve made it a priority to minimize the long-term side effects of cancer. Smita Bhatia, MD, MPH with Children’s of Alabama has dedicated much of her career to investigating survivorship and the impact of adherence in children with ALL. Her research has helped us understand that kids from disadvantaged neighbors often have a higher risk of developing later health complications and how the age a child is diagnosed also plays a role in their long-term health outcomes.
Both Sarah Alexander, MD with SickKids in Toronto and Lisa Jacola, PhD with St. Jude are leading research to understand how anesthesia and chemotherapies impact a child’s cognitive skills. Many end up having a difficult time concentrating or comprehending what they’re learning. We’re all looking forward to learnings from Lamia Barkat, PhD who works with me at CHOP, and is researching psychosocial risk and resilience in children with cancer.
We also have researchers studying how cancer treatment impacts a child’s physical body. Nina Kadan-Lottick, MD with Georgetown University is studying how improving mobility through exercise can help with long-term health in children with ALL. Elena Ladas, PhD at Columbia University is studying the impact of malnutrition and obesity on short and long-term outcomes in children with ALL.
What is the one thing you want everyone to know about COG?
What’s special about COG is that with every new therapy or patient experience study, we involve experts from all areas of cancer research. From each study, we’re going to learn about the biology of leukemia, the toxicity of treatments, and how things like socioeconomic factors impact outcomes.
I’d like to offer a second thing I want everyone to know – we can only move forward if we have more funding across basic sciences, translational science and clinical science. This includes studying the genetics of cancer and the genetics of our patients. A holistic approach will be the key to more breakthroughs.
Dr. Teachey's sons
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How does philanthropy play a role in pediatric cancer research?
We’ve made so much progress in pediatric cancer research because of the partnership between medicine, science, philanthropy, advocacy and the government. Some of these partnerships started in the 1950s. As a researcher and provider, one of the most meaningful things I’ve seen over the years is how dedicated donors are to offer their support where the need is greatest. Their generosity and trust in us have enabled us to build really strong care programs side-by-side with effective research programs. All I can say to our COG Foundation donors is thank you for your support. It means a great deal to all of us at COG and our hospital teams who are caring for patients. |
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What’s the best part of your job?
Oncology is a holistic medicine. We’re here to take care of patients through their entire cancer experience. As a father of three who has been happily married for over 20 years, it is impossible to fathom what our patient families go through. I really enjoy being one part of a team of nurses, case managers, child life specialists and others who our patient families know and trust. |
Dr. Teachey's sister, wife and daughter.
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I also enjoy working closely with patient advocates, like Kimberly Buff the founder of the nonprofit, Momcology. Their team is helping us understand the impact of cancer on a child and their family. What doctors think are the biggest issues with treatments are not necessarily what the patients and kids think are the hardest parts.
Altogether, the best part is seeing the advances we make have an impact on my patients. And because of COG, I know this same impact is happening across the country and globe – and that's a big motivator for me.
Altogether, the best part is seeing the advances we make have an impact on my patients. And because of COG, I know this same impact is happening across the country and globe – and that's a big motivator for me.