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Myeloid disease

Tallman, Martin S

Current Opinion in Hematology: March 2009 - Volume 16 - Issue 2 - p 63
doi: 10.1097/MOH.0b013e3283279a76
Myeloid disease: Edited by Martin S. Tallman

Northwestern University, Feinberg School of Medicine, Division of Hematology-Oncology, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, USA

Correspondence to Dr Martin S. Tallman, MD, Northwestern University Medical School, Division of Hematology/Oncology, 676 N. St. Clair Street, Suite 850, Chicago, IL 60611, USA Tel: +1 312 695 0184; e-mail:

Four major areas of advancement have occurred during the last decade in hematologic malignancies, particularly acute myeloid leukemia. These include insights into the molecular pathogenesis, the identification of more refined prognostic factors, the development of novel agents directed at specific molecular and antigenic determinants, and alternative transplant strategies to exploit the potent graft-versus-leukemia effect. Each of these areas is addressed in this volume of Current Opinion in Hematology. Dr Krzysztof Mrózek et al. (pp. 64–69) open with a comprehensive discussion of molecular signatures in acute myeloid leukaemia that is understandable even for the novice in this area. Dr Pearlie Epling-Burnette and Dr Alan List (pp. 70–76) lay the groundwork for a discussion of treatment of the myelodysplastic syndromes by addressing advances in understanding the molecular pathogenesis of these disorders. It was only a few years ago that the treatment of myelodysplastic syndromes relied only on supportive care. Now, three agents are approved, Dr Raphael Itzykson and Dr Pierre Fenaux (pp. 77–83) address the optimal sequencing of treatments for patients with myelodysplastic syndromes. Treatment of hematologic malignancies other than with conventional cytotoxic chemotherapy continues to be explored. Dr Kevin Petrie et al. (pp. 84–91) provide a detailed discussion of differentiation therapy. At the present time, differentiation therapy is only effective in acute promyelocytic leukemia. However, the authors discuss the available data in other hematologic malignancies and comment on the potential for this strategy in the future. Patients with core binding factor acute myeloid leukemia have a relatively favorable prognosis compared with most other subtypes. There are data to suggest that multiple cycles of high-dose ara-C provides the best outcome. However, as reports including large numbers of patients have been published, the effectiveness of high-dose ara-C in this setting has been revisited by Dr Hervé Dombret et al. in this volume (pp. 92–97). One of the most important advances has been in the area of molecular prognostic factors. Dr Richard Shelenk and Dr Konstanze Döhner (pp. 98–104) discuss how the presence of certain molecular prognostic factors such as NPM1 influences treatment decisions. The optimal postremission strategy for most patients with acute myeloid leukemia has not been determined. Dr Jeffery Lancet and Dr Judith Karp (pp. 105–111) address novel postremission strategies other than hematopoietic stem cell transplantation. Patients who relapse after hematopoietic stem cell transplantation have a poor prognosis. Although further exploitation of graft-versus-leukemia effect is appealing, the second transplants are difficult to carry out. Dr Lisa Arfons et al. (pp. 112–123) provide a detailed discussion of the second hematopoietic stem cell transplantation in myeloid malignancies. Dr Anjali Advani and Dr Mary Laughlin (pp. 124–128) discuss the exciting alternative source of stem cells for transplantation, namely umbilical cord. This source of stem cells can be procured quickly and may continue to expand the population of patients who may benefit from transplantation. The last three chapters in this volume address hematologic malignancies other than acute myeloid leukemia and the myelodysplastic syndromes. The various myeloproliferative disorders have comprised another area in which little was known about the pathogenesis, and few treatment options have been available. The identification of JAK2 mutations has catalyzed exciting laboratory research to further decipher the molecular pathogenesis and in turn develop novel treatment strategies. Dr Giovanni Barosi and Dr Vittorio Rosti (pp. 129–134) discuss novel strategies for patients with the chronic myeloproliferative disorders. The development of the tyrosine kinase inhibitors for chronic myelogenous leukemia has completely changed the field during the last decade. Multiple tyrosine kinase inhibitors are now available, and monitoring response has become a focus of much discussion. In this volume, Dr Michael Mauro (pp. 135–139) provides his perspective on the appropriate sequencing of the burgeoning number of tyrosine kinase inhibitors for this specific myeloproliferative disorder. Myelofibrosis has been the thorn in the side of most hematologists. One aggressive therapeutic strategy has been allogeneic hematopoietic stem cell transplantation. Dr Dae Young Zang and Dr Joachim Deeg (pp. 140–146) complete this volume with an up-to-date discussion of the benefits of this strategy. These authoritative chapters will provide the reader with state-of-the-art information in a rapidly changing field.

© 2009 Lippincott Williams & Wilkins, Inc.