The clinical management of leukemia☆

Abstract 

Empirical systems of treatment, employing chemical agents and radiation in a manner specified for each type of leukemia, can relieve symptoms and offer the chance of an extended period of relative well-being to victims of leukemia. The use of whole blood transfusions and antibiotics, as the indications arise, is important if the best result is to be achieved.

Treatment of acute lymphoblastic leukemia frequently produces full remissions and, compared to untreated patients, at least a twofold increase in the duration of life after the onset of symptoms. In contrast, in the treatment of acute myeloblastic leukemia, neither full remission nor prolongation of life occurs frequently, although some benefit is sometimes obtained.

Therapy of chronic myelocytic leukemia may produce full remissions with great regularity; however, an accompanying prolongation of life has not been reported in most series. In chronic lymphocytic leukemia, remissions are often not as complete as in chronic myelocytic leukemia but symptoms are often less severe, the disease is more indolent and, in the experience of some, longevity is greater.

Although leukemia is inevitably fatal, for the untreated patient the period of suffering is longer, on the average, than for one who has been treated. In the end, the course of events, both in those who are treated as well as in the untreated, is likely to be trying for the patient, for his family and for the physician. Nevertheless, there are few families who regret that palliative therapy was undertaken.

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