Abstract
Acute lymphocytic leukemia (ALL) of childhood has emerged over the past 30 years as the therapeutically most responsive disseminated form of cancer. The success of treating ALL has been the result of the simultaneous occurrence of two factors: ALL is a relatively responsive tumor and (b) a systematic approach has evolved for the evaluation of, and development of therapy for, this form of cancer. Those who treat childhood ALL cannot take full credit for the success because, as explained below, the single most important factor in the achievement has been the biologic property of the tumor, over which physicians have no control. The central question is, why has childhood ALL responded to treatment much better than acute myelocytic leukemia (AML) at any age, or ALL in adults? Several factors contribute to this difference:
Childhood ALL is highly responsive to available therapy. After Dr. Sidney Farber and his colleagues introduced aminopterin as the first effective chemotherapeutic agent for acute leukemia, a succession of new agents were introduced which were quite effective as single agents. This included, in the years up to 1960, corticosteroids, mercaptopurine, cyclophosphamide, and vincristine, as well as the analogue of aminopterin — methotrexate. Each of these agents produced complete remissions in a significant proportion of patients and partial responses in an even larger fraction. To put this in proper perspective, one finds it difficult, even today, to identify any other disseminated form of cancer in which one may achieve complete responses with each of five agents used independently.
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References
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Simone, J.V. (1979). Childhood Acute Lymphocytic Leukemia — A Model for Therapeutic Strategies in Hemopoietic Neoplasia. In: Gross, R., Hellriegel, KP. (eds) Strategies in Clinical Hematology. Recent Results in Cancer Research / Fortschritte der Krebsforschung / Progrès dans les recherches sur le cancer, vol 69. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-81371-9_6
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DOI: https://doi.org/10.1007/978-3-642-81371-9_6
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