When the most common adult leukemia in the United States was last reviewed by the New England Journal of Medicine (NEJM) in 1995, it was seen through the eyes of theories that dated back to the 1960s.
As such, the journal recently invited three of the world's foremost experts on chronic lymphocytic leukemia (CLL) to write an authoritative update covering the transformation in the scientific community's knowledge of CLL that has occurred over the past decade. The review appears in the February 24 issue.
Two of the expert authors are with the North Shore-Long Island Jewish (LIJ) Health System: Nicholas Chiorazzi, MD, director and CEO of the Institute for Medical Research at North Shore-LIJ in Manhasset, NY, who also serves as Professor of Medicine at New York University School of Medicine, and Kanti R. Rai, MB, BS, investigator at the Institute for Medical Research, chief of hematology-oncology at LIJ Medical Center in New Hyde Park, NY, and the Joel Finkelstein Cancer Foundation Professor of Medicine at Albert Einstein College of Medicine. The third author, Manlio Ferrarini, MD, is with the National Institute for Cancer Research in Genoa, Italy (Istituto Nazionale per la Ricerca sul Cancro, Genova, Italia).
"Previous theories about the development and progression of chronic lymphocytic leukemia require revision. With new molecular and protein markers now identified, patients with features that portend poor outcomes may soon be treated earlier and more effectively," said Dr. Chiorazzi.
"Once these new prognostic markers are clinically available to doctors, and after large-scale trials testing early intervention are completed, the 'watchful waiting' practice may be abandoned in many cases," said Dr. Rai, who treats many CLL patients. "New and upcoming discoveries made collectively by us and many other scientists around the world may alter the natural history of this currently incurable leukemia," he added.
A decade ago, CLL was considered a uniform disease of immature white blood cells that didn't die, with the slow rise in leukemia cell count seen in patients due to an accumulation of these immature and incompetent white blood cells. Scientists have since discovered that CLL cells do indeed turn over, with the accumulation over time a result of the difference in the birth and death rates of the leukemia cells.