[The future of oncohematology].
The last 40 years have witnessed important changes in the understanding and treatment of oncohematological affections. Palliative therapy was gradually replaced by chemotherapy (CT) which rapidly proved unexpectedly effective. In 1948, the first antifolic drugs, aminopterin and methotrexate, were discovered, followed in 1950 by the corticoids and in 1953 by antipurine agents. By 1967, a combination of these drugs yielded a survival index of 50% in acute lymphoblastic leukemia (ALL) with a progressive increase in all important cancer centers today, including in GATLA (Argentine Group for Acute Leukemia). As for acute myeloblastic leukemia (AML) the CT results were not as spectacular although now there is a 25% survival index which reaches 40-50% in young adults. As for allogeneic transplant in acute leukemia, its use must be evaluated for each patient and for each circumstance. Leukemias are genetic diseases for which gene therapy undoubtedly has potential value. However, the problems raised by the election of the right gene or gene marker and specially of the adequate vector have not yet been solved. In Hodgkin's disease, the results obtained with CT since the decade of the 60s have been spectacular and today different combinations of drugs have yielded a survival rate above 80%. Immunotherapy with or without CT has opened up a completely new and promising field. The route from basic research to clinical application has been long and arduous but the results obtained in leukemia and lymphomas have undoubtedly been life-saving and hopefully will open up even better possibilities in the near future.
de Tezanos Pinto
M
M
Academia Nacional de Medicina, Las Heras 3092, 1425 Buenos Aires, Argentina. academia@cardioweb.net.ar
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D018572:Disease-Free Survival; D005544:Forecasting; D015316:Genetic Therapy; D006801:Humans; D007167:Immunotherapy; D007945:Leukemia, Lymphoid / Q000628:therapy*; D008495:Medical Oncology / Q000639:trends*