History of Acute Leukemia

Abstract

The recognition of Acute Leukemia as a malignancy of the blood cells is usually credited to Virchow [1] as is the term Leukemia (Weisses Blut) [2]. The following century provided extensive details of the pathology and cytology of this disorder. But, the first mention of any attempt to alter its natural history was reported in 1948 by Dr. Farber. He described temporary remissions of the disease and reported that the disease almost invariably recurred despite continuous administration of aminopterin [3]. In 1949, Pearson reported cortisone-induced regressions of lymphoid tumors [4], which was confirmed by Dr. Farber in 1950 showing remissions in childhood acute leukemia [5]. Following the Nobel prize winning research of Hitchings and Elion on the biochemistry of purine analogs [6], Dr. Burchenal reported remissions in acute leukemia with 6-mercaptopurine in 1953 [7]. Despite having three (3) unique molecules effective in inducing temporary remission in patients with acute leukemia, a careful review of the natural history of the disease was published by McMann and Foreman in 1957. They showed that, for over 600 patients studied between 1943 and 1952, the median survival was approximately 6 weeks and 95 % of the patients were dead by 12 months after diagnosis [8]. In 1955, the largest and most authoritative group in hematology, Dr. Wintrobe’s group in Utah reported, “It was not possible to demonstrate that the newer therapies (folic acid antagonists, ACTH, cortisone, and 6-mercaptopurine) significantly increased the total survival in these representative groups” [9]. In fact, the authors recommended that these therapies not be administered to patients since they were simply prolonging the horrible clinical manifestations of a uniformly fatal disease.