The Chronic Leukemias

  • G. P. Canellos
Part of the UICC International Union Against Cancer book series (UICCI)

Abstract

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 [1]. 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 [2]. 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.

Keywords

Leukemia Oncol Interferon Cyclophosphamide Prednisone 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Champlin RE, Golde DW (1985) Chronic myelogenous leukemia: recent advances. Blood 65: 1039–1047PubMedGoogle Scholar
  2. 2.
    Thomas ED, Clift RA, Fefer A et al. (1986) Marrow transplantation for the treatment of chronic myelogenous leukemia. An Intern Med 104: 155–163Google Scholar
  3. 3.
    Talpaz M, Kantarjian HM, McCredie K et al. (1986) Hematologic remission and cytogenetic improvement induced by recombinant human interferon alphas in chronic myelogenous leukemia. N Engl J Med 314: 1065–1069PubMedCrossRefGoogle Scholar
  4. 4.
    Wiernik PH (1984) The current status of therapy for the prevention of blast crisis of chronic myelocytic leukemia. J Clin Oncol 2: 329–335PubMedGoogle Scholar
  5. 5.
    Bakhshi A, Minowada J, Arnold A et al. (1983) Lymphoid blast crises of chronic myelogenous leukemia represents stages in the development of B-cell precursors. N Engl J Med 309: 825–831CrossRefGoogle Scholar
  6. 6.
    Karp DD, Parker LM, Binder N et al. (1985) Treatment of the blastic transformation of chronic granulocytic leukemia using high dose BCNU chemotherapy and cryopreserved autologous peripheral blood stem cells. Am J Hematol 18: 243–249PubMedCrossRefGoogle Scholar
  7. 7.
    Rozman C, Montserrat E, Feliu E et al. (1982) Prognosis of chronic lymphocytic leukemia: a multivariate survival analysis of 150 cases. Blood 59: 1001–1005PubMedGoogle Scholar
  8. 8.
    Keller JW, Knospe WH, Raney M et al. (1986) Treatment of chronic lymphocytic leukemia using chlorambucil and prednisone with or without cycle-active consolidation chemotherapy. Cancer 58: 1185–1192PubMedCrossRefGoogle Scholar
  9. 9.
    Harousseau JL, Flandrin G, Tricot G, Brouet JC et al. (1981) Malignant lymphoma supervening in chronic lymphocytic leukemia and related disorders. Cancer 48: 1302–1308PubMedCrossRefGoogle Scholar
  10. 10.
    Sokal JE, Cox EB, Baccarani M et al. (1984) Prognostic discrimination in “good risk” chronic granulocytic leukemia. Blood 63: 789–799PubMedGoogle Scholar
  11. 11.
    Dillman RO, Shawler DL, Billman JB, Royston I (1984) Therapy of chronic lymphocytic leukemia and cutaneous T-cell lymphoma with T101 monoclonal antibody. J Clin Oncol 2: 881–891PubMedGoogle Scholar
  12. 12.
    Konopka JB, Watanabe SM, Witte ON (1984) An alteration of the human c-abl protein in K562 leukemia cells unmasks associated tyrosine kinase activity. Cell 37: 1035–1042PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • G. P. Canellos

There are no affiliations available

Personalised recommendations