Chronic Leukemias: Oncogenes, Chromosomes, and Advances in Therapy

Substantial advances have been made recently in understanding the biology and treatment of the chronic leukemias. Recent data are summarized on the role of retroviruses, oncogenes, and chromosomal rearrangements in the pathophysiology of these disorders, particularly the translocation and abnormal transcription of the c-abl oncogene in chronic myelogenous leukemia and the identification of a family of human T-cell leukemia viruses as causative agents in certain lymphoid leukemias. Interferon, monoclonal antibodies, and other biologic agents have been evaluated as therapy for chronic leukemias. Alpha-interferon has definite efficacy in therapy for hairy cell leukemia, an otherwise refractory malignancy. Intensive chemoradiotherapy with bone marrow transplantation has been established as effective therapy, providing long-term disease-free survival, for selected patients with chronic myelogenous leukemia and possibly other forms of chronic leukemias.