The Chronic Leukemias
This disease provides an interesting model for the study of human bone marrow stem cell physiology as well as for human neoplasia since, in most instances, it is a disease that will predictably pass from a status of hyperplasia to dedifferentiation blast cell leukemia . A most interesting development in the treatment of this disease has been the discovery that the chronic phase of chronic granulocytic leukemia (CGL) can be effectively obliterated by high-dose chemoradiotherapy followed by an allogeneic or syngeneic marrow graft. The data clearly show that the results are superior if the patients are given a transplant in the chronic phase of the disease as opposed to the accelerated (or blastic) phase, since the disease becomes progressively refractory to the obliteration of the last neoplastic cell by chemoradiotherapy . New developments in the treatment of donor grafts by techniques designed to remove T cells in general or specific T-cell subsets have resulted in a marked diminution in the incidence of graft-versus-host disease and the resulting mortality. However, an increased incidence of graft rejection has been noted, indicating that perhaps a small degree of graft-versus-leukemia is required for the successful obliteration of the last Philadelphia chromosome-bearing cell. If the patient lacks a suitable histocompatible donor, then occasional patients are given mismatched grafts, usually with poor results. The stable/chronic phase is managed very easily by conventional oral alkylating agents, such as busulfan and the more recently introduced hydroxyurea. The latter is probably the treatment of choice since it is not associated with any other visceral toxicity or long-term myelosuppression. Hydroxyurea is the drug with which all new therapies should be compared for the treatment of the chronic phase.
KeywordsLeukemia Oncol Interferon Cyclophosphamide Prednisone
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