BIOLOGY AND THERAPY OF ACUTE LEUKEMIA

Transcription

1 BIOLOGY AND THERAPY OF ACUTE LEUKEMIA

2 DEVELOPMENTS IN ONCOLOGY F.J. Cleton and J.W.I.M. Simons, eds.: Genetic Origins of Tumour Cells J. Aisner and P. Chang, eds.: Cancer Treatment and Research B.W. Ongerboer de Visser, D.A. Bosch and W.M.H. van Woerkom-Eykenboom, eds.: Neurooncology: Clinical and Experimental Aspects. 9O X. K. Hellmann, P. Hilgard and S. Eccles, eds.: Metastasis: Clinical and Experimental Aspects H.F. Seigler, ed.: Clinical Management of Melanoma P. Correa and W. Haenszel, eds.: Epidemiology of Cancer of the Digestive Tract L.A. Liotta and I.R. Hart, eds.: Tumour Invasion and Metastasis J. Banoczy, ed.: Oral Leukoplakia C. Tijssen, M. Halprin and L. Endtz, eds.: Familial Brain Tumours F.M. Muggia, C.W. Young and S.K. Carter, eds.: Anthracycline Antibiotics in Cancer B.W. Hancock, ed.: Assessment of Tumour Response. 9O X. D.E. Peterson, ed.: Oral Complications of Cancer Chemotherapy R. Mastrangelo, D.G. Poplack and R. Riccardi, eds.: Central Nervous System Leukemia. Prevention and Treatment A. Polliack ed.: Human Leukemias. Cytochemical and Ultrastructural Techniques in Diagnosis and Research W. Davis, C. Maltoni and S. Tanneberger, eds.: The Control of Tumor Growth and its Biological Bases A.P.M. Heintz, C. Th. Griffiths and J.B. Trimbos, eds.: Surgery in Gynecological Oncology M.P. Hacker, E.B. Double and I. Krakoff, eds.: Platinum Coordination Complexes in Cancer Chemotherapy M.J. van Zwieten. The Rat as Animal Model in Breast Cancer Research: A Histopathological Study of Radiation- and Hormone-Induced Rat Mammary Tumors B. Lowenberg and A. Hogenbeck, eds.: Minimal Residual Disease in Acute Leukemia I. van der Waal and G.B. Snow, eds.: Oral Oncology B.W. Hancock and A.M. Ward, eds.: Immunological Aspects of Cancer K.V. Honn and B.F. Sloane, eds.: Hemostatic Mechanisms and Metastasis K.R. Harrap, W. Davis and A.N. Calvert, eds.: Cancer Chemotherapy and Selective Drug Development X. V.D. Velde, J.H. Comelis and P.H. Sugarbaker, eds.: Liver Metastasis D.J. Ruiter, K. Welvaart and S. Ferrone, eds.: Cutaneous Melanoma and Precursor Lesions S.B. Howell, ed.: Intra-Arterial and Intracavitary Cancer Chemotherapy D.L. Kisner and J.F. Smyth, eds.: Interferon Alpha-2: Pre-Clinical and Clinical Evaluation P. Furmanski, J.C. Hager and M.A. Rich, eds.: RNA Tumor Viruses, Oncogenes, Human Cancer and Aids: On the Frontiers of Understanding J.E. Talmadge, I.J. Fidler and R.K. Oldham: Screening for Biological Response Modifiers: Methods and Rationale J.C. Bottino, R.W. Opfell and F.M. Muggia, eds.: Liver Cancer P.K. Pattengale, R.J. Lukes and C.R. Taylor, eds.: Lymphoproliferative Diseases: Pathogenesis, Diagnosis, Therapy F. Cavalli, G. Bonadonna and M. Rozencweig, eds.: Malignant Lymphomas and Hodgkin's Disease

3 BIOLOGY AND THERAPY OF ACUTE LEUKEMIA Proceedings of the Seventeenth Annual Detroit Cancer Symposium - April 12-13, 1984 edited by Laurence Baker Frederick Valeriote Voravit Ratanatharathom ~ " Martinus Nijhoff Publishing a member oj the Kluwer Academic Publishers Group Boston/Dordrecht/Lancaster

4 Distributors for North America: Kluwer Academic Publishers 190 Old Derby Street Hingham, MA Distributors for all other countries: Kluwer Academic Publishers Group Distribution Centre P.O. Box AH Dordrecht The Netherlands This Symposium was presented by School of Medicine, Division of Oncology; Comprehensive Cancer Center of Metropolitan Detroit; and Harper-Grace Hospitals. Editorial Assistant: Ms. Linda Leino Library of Congress Cataloging In Publication Data Detroit Cancer Symposium (17th: 1984) Biology and therapy of acute leukemia. (Developments in oncology) I. Leukemia-Congresses. 2. Leukemia-Treatment Congresses. I. Baker, Laurence H. II. Valeriote, Frederick. III. Ratanatharathom, Voravit. IV. Title. V. Series. [DNLM: I. Leukemia-congresses. 2. Leukemia -therapy-congresses. WI DE998N / WH 250 D b] RC643.D ' ISBN-13: e-isbn-13: DOl: / Copyright 1985 by Martinus Nijhoff Publishing, Boston Softcover reprint of the hardcover 1st edition 1985 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise, without written permission of the publisher, Martinus Nijhoff Publishing, 190 Old Derby Street, Hingham, Massachusetts

5 PARTICIPANTS PREFACE CONTENTS vii x 1. The Impact of Treatment on the Natural History of Acute Leukemia Emil J Freireich 2. Experimental Rationale for Therapy in the Treatment of Acute Leukemia Frederick A. Valeriote 3. Clinical Laboratory Methods Used for the Classification of Acute Leukemia Margarita Palutke 4. HTLV-II and Human Leukemia William Wachsman, Judith C. Gasson, David W. Golde and Irvin S.Y. Chen 5. Oncogene Expression and Arrangement in Human Leukemia Steven J. Collins 6. Clonal Variation and Phenotypic Progression in Retrovirus Transformed Leukemia Cells David L. Hines 7. Chemotherapeutic Agents as Differentiation Inducers Alexander Bloch 8. Modes of Drug Resistance in Acute Leukemias David Kessel 9. The Evolution of Therapy for Acute Lymphatic Leukemia in Children Teresa Vietti and James Boyett 10. Prognostic Factors in Childhood Acute Lymphoblastic Leukemia: Correlation with Treatment Response Y. Ravindranath 11. Clinical Trials in Adult ANLL: An Overview Michael T. Rooney 12. Allogeneic Marrow Transplantation for Acute Nonlymphoblastic Leukemia in Adults Frederick R. Appelbaum and E. Donnall Thomas v

6 vi 13. Treatment Choices for Patients with Acute Nonlymphocytic Leukemia in Remission: Chemotherapy and Bone Marrow Transplantation Harvey D. Preisler Autologous Bone Marrow Transplantation in Acute Leukemia Voravit Ratanatharathorn, Chatchada Karanes, Fr. Joe Mahoney and Frederick R. Appelbaum 15. Treatment of Leukemia and Lymphoma with Biological Response Modifiers Kenneth A. Foon 16. Transfusion Therapy for the Support of Leukemia Patients Chatchada Karanes and Voravit Ratanatharathorn 17. Leukemia: Hemorrhagic and Thrombotic Complications John A. Penner

7 LIST OF PARTICIPANTS Frederick R. Appelbaum, M.D. Associate Professor of Medicine University of Washington School of Medicine Associate Member, Fred Hutchinson Cancer Research Center Seattle, Washington Laurence H. Baker, D.O. Professor of Medicine Director, Division of Medical Oncology Deputy Director of the Comprehensive Cancer Center of Metropolitan Detroit Alexander Bloch, Ph.D. Principal Cancer Research Scientist Department of Experimental Therapeutics Roswell Park Memorial Institute Buffalo, New York James M. Boyett, Ph.D. Statistician, Statistical Office Pediatric Oncology Group University of Florida Gainesville, Florida Irvin S.Y. Chen, Ph.D. Assistant Professor of Medicine Division of Hematology/Oncology UCLA School of Medicine Los Angeles, California Steven J. Collins, M.D. Assistant Professor of Medicine University of Washington Seattle, Washington Kenneth A. Foon, M.D. Head, Clinical Investigations Section Biological Response Modifiers Program National Cancer Institute Frederick, Maryland Emil J Freireich, M.D., D.Sc. (Hon.) Chairman, Department of Hematology The University of Texas System Cancer Center M.D. Anderson Hospital and Tumor Institute Houston, Texas

8 vili Judith C. Gasson, Ph.D. Assistant Professor of Medicine Division of Hematology/Oncology UCLA School of Medicine Los Angeles, California David W. Golde, M.D. Professor of Medicine Chief, Division of Hematology/Oncology UCLA School of Medicine Los Angeles, California David L. Hines, Ph.D. Assistant Member Biomedical Research Lab Trudeau Institute, Inc. Saranac Lake, New York Chatchada Karanes, M.D. Assistant Professor of Medicine Division of Medical Oncology David Kessel, Ph.D. Professor of Medicine Division of Medical Oncology Father Joe Mahoney, M.Div. Chaplain for the Bone Marrow Transplantation and Hematologic Malignancies Service Harper-Grace Hospitals Margarita Palutke, M.D. Professor of Pathology Head, Section of Hematopathology, Pathology Department John A. Penner, M.D. Professor of Internal Medicine Director, Hematology/Oncology Section Michigan State university East Lansing, Michigan

9 ix Harvey D. Preisler, M.D. Deputy Chief Department of Medical Oncology Roswell Park Memorial Institute Buffalo, New York Voravit Ratanatharathorn, M.D. Head, Bone Marrow Transplantation Unit Division of Medical Oncology Yaddanapudi Ravindranath, M.B., B.S. Associate Professor of Pediatrics Children's Hospital of Michigan Michael T. Rooney, M.D. Valley Medical Center Lewiston, Idaho E. Donnall Thomas, M.D. Professor of Medicine University of Washington School of Medicine Associate Director for Clinical Research, Fred Hutchinson Cancer Research Center Seattle, Washington Frederick A. Valeriote, Ph.D. Professor of Medicine Associate Director Division of Medical Oncology Teresa J. Vietti, M.D. Professor of pediatrics Mallinckrodt Dept. of Pediatrics Washington University School of Medicine Division of Hematology/Oncology St. Louis Children's Hospital St. Louis, Missouri William Wachsman, M.D., Ph.D. Fellow, Div. of Hematology/Oncology UCLA School of Medicine Los Angeles, California

10 PREFACE This year notes two major changes in the annual Detroit Cancer Symposium. The first is our intention of selecting topics of broad interest to the cancer community and examining the subject from both a basic laboratory and clinical viewpoint. In this way, the importance of both elements of cancer research are noted and the interplay between them emphasized. Further, we believe that Symposia such as this act to stimulate the basic scientist and clinician to continue their studies with the knowledge of the impact that each has upon the other and the necessary cooperation required to solve the cancer problem. The second change is the publication of this Symposium. The previous sixteen were not committed to manuscript form. Given the change in format and intent of the series, we believe that this and subsequent volumes will make important contributions to the cancer literature. The topic of "Biology and Therapy of Acute Leukemia" was chosen for the first Symposium because of its historical significance in cancer chemotherapy. The therapeutic rationale for human leukemia is the result of understanding the basic tumor biology largely derived from transplantable leukemias in experimental animals. It is through these models, as discussed by Dr. Fred Valeriote, that we learned the cellular kinetics of leukemia, the antileukemic effects of new agents and the effect of growth perturbation by various chemotherapeutic agents and their combinations. The influence of basic knowledge in the therapy of human leukemia is evident in the design of clinical trials over the past four decades and is demonstrated by doseschedule oriented combination chemotherapy, re-induction chemotherapy using non-cross resistant regimens, immunotherapy and bone marrow transplantation. While it is clear that experimental models have significantly contributed to the basic formulation of current treatment strategy, we must also recognize both the limitations of these models and the biological differences between mice and humans. Consequently, we cannot expect that a single strategy would work for all patients whether the rationale is from either experimental or clinical studies. This latter point was elegantly elaborated by Dr. Emil Freireich where he has identified pronounced response heterogeneity of patients to standard therapies and is identifying these different subpopulations. Newer methods of classification of leukemic cells by cytochemistry and immunologic phenotypes described by Drs. Kenneth Foon and Margarita Palutke is perhaps one of the most obvious examples of demonstrating and analyzing tumor heterogeneity. Possibly these tools will allow us to explain the unique clinical expressions in certain subtypes of leukemia. Studies reported here from Dr. David Hine's laboratory provide an ~xperimental demonstration of clonal variability in retrovirus transformed leukemia cells and in particular, heterogeneity in differentiation capabilities.

11 An important goal of this symposium was to examine and update the current therapeutic results. Complete and critical reviews of the clinical trials in acute lymphoblastic leukemia were provided by Drs. Teresa vietti and Y. Ravindranath for childhood leukemia. Drs. Michael Rooney and Harvey Preisler carried out a parallel analysis for acute non-lymphocytic leukemia. The role of allogeneic bone marrow transplantation in acute non-lymphocytic leukemia was summarized by Dr. Fred Appelbaum, particularly the results of patients in first remission. Other new avenues of therapy such as autologous bone marrow transplantation and the use of differentiating agents were also reviewed. The difficult task of discussing the transfusion support, and management of thrombotic and hemorrhagic complications were undertaken by Drs. Chatchada Karanes and John Penner. Prospects for the future lie in many areas. Therapeutic interventions can take account of recent basic studies in drug resistance and cell differentiation. The paramount problem of drug resistance, the varied underlying biochemical basis, as well as potential solutions to the problem were discussed by Dr. David Kessel. The intriguing possibility of controlling or modifying the differentiation "program" of a tumor cell was reviewed by Dr. Alexander Bloch. In this regard, use of potentially non-toxic differentiating factors for leukemia would be a major therapeutic advance. An exciting and topical area of research at the present time involves the role oncogenes may play in the biology, diagnosis and therapy of leukemia as exemplified in the discussions of oncogene expression. Dr. Steven Collins reviewed the specific oncogenes associated to date with experimental and human leukemias and their possible "normal" role in cellular physiology. In terms of a specific leukemia virus, the discussion of human tumor leukemia virus (HTLV) and specifically the characterization by Dr. David Golde of HTLV-II, demonstrates wh~ a major and radical breakthrough in our understanding of the biology of leukemogenesis seems imminent. We believe that this monograph will be valuable to basic scientists as well as clinicians who have interests in the fielc of acute leukemia. Reviews of the history of therapy, presentday treatment rationale and future, though now experimental, therapies are analyzed and discussed.