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Transferring hematopoietic stem cells and immune cells has continued to be a promising therapeutic alternative and a fascinating area of cell biology as well as a field of persistent procedural problems. This explains why substantial parts of basic research on cell growth and differentiation, immune tolerance and antitumor effects, gene transfer, minimal residual disease and supportive care have settled around clinical transplantation in hematology and oncology. This second volume updates the current role of allogeneic and autologous transplantation in leukemias, lymphomas and solid cancers, including controversial strategies and novel experimental approaches. Outstanding representatives of leading groups guarantee first-hand information and indicate how we can work and cooperate more effectively to the benefit of our patients.
Hematopoietic stem cell and immune cell transplantation has cont-
ued as a promising therapeutic alternative and a fascinating area
of cell biology as well as a field of persistent procedural
problems. This - plains why substantial parts of basic research on
cell growth and d- ferentiation, immune tolerance and antitumor
effects, gene transfer, minimal residual disease and supportive
care have settled around cli- cal transplantation in hematology and
oncology. This second volume again updates the current role of
allogeneic and autologous transpl- tation in leukemias, lymphomas
and solid cancers, including cont- versial strategies and novel
experimental approaches. In particular, cellular immune therapy,
new conditioning strategies, mismatched donor transplantation,
updated clinical transplantation, antiangiogenesis and strategies
against fungal infections are focused upon. Outstanding
representatives of leading groups guarantee fir- hand information
and indicate how we can work and cooperate more effectively to the
benefit of our patients. The editors are indebted to the
Gesellschaft zur Bekampfung der Krebskrankheiten
Nordrhein-Westfalen for a substantial support of the publication.
They also acknowledge the major contribution of Beate Kosel as
coordinator of the editorial work."
Since 1987 Acute Leukemias (AL) has regularly reported on the state
of the art in the rapidly growing, successful and exciting field of
biology and management of these diseases. In this volume large
multicenter clinical trials again form the solid basis for the
investigation of leukemic cell biology, the detection of biologic
subgroups, their differential response to alternative treatment
strategies and the further development of therapy. In particular,
this volume addresses mechanisms of chromosomal translocations and
transcription factors, risk-adapted treatment strategies,
differentiation therapy, secondary AL, special aspects in older
patients, and adoptive immunotherapy. Besides the antileukemic
approaches, supportive treatment with new antimicrobial substances
and growth factors is updated. As a forum of worldwide activities
in the field of AL this volume contains both exhaustive overviews
on major clinical issues and preliminary data and hypotheses not
previously published.
Some three decades after bone marrow transplantation was introduced
in the field of hematology and oncology, transplantation today
continues to rapidly grow and expand into a variety of new
modalities. Peripheral blood has been established as an effective
source of autologous progenitor cells. Furthermore, the
graft-versus-leukemia effect has resulted in novel strategies of
adoptive immunotherapy for cancer. Finally, approaches to gene
transfer and therapy are utilizing transplantation methodologies
and can augment their effects. Current results, new developments
and perspectives are presented in this volume. Conventional and
innovative experimental approaches, the past and the future of bone
marrow transplantation are reviewed and discussed by leading
representatives.
Following the major breakthroughs in the and frequent and thorough
exchange of treatment of acute leukemias in the seven- information.
Hence, it was felt that a spe- ties by the introduction of
intensive combi- cial series of symposia should be devoted to
nation regimens, therapeutic progress has "Pharmacokinetics and
Management of slowed down and the impression of stagna- Relapsed
and Refractory Disease" comple- menting the established meetings on
"Prog- tion may even have occured. In contrast, the knowledge about
the biology of leu- nostic Factors and Treatment Strategies" kemias
is rapidly expanding and allows new which will proceed in parallel.
It was the insights into the pathophysiology of the aim of the
international symposium disease. Further improvements also come
"ACUTE LEUKEMIAS - Pharmacokine- from a better understanding of the
pharma- tics and Management of Relapsed and cokinetics and
pharmacodynamics of cyto- Refractory Disease" to provide an update
static drugs and their mechanisms of action. of the present
knowledge in this area and to Hence, novel treatment modalities can
be stimulate further developments. As a sign developed on a more
solid basis and ration- for the closing distance between countries
al. These achievements need to be comple- and the development of
effective world- mented by effective eradiation wide cooperation
this symposium emerged of residual disease or its permanent control
and new from the joint efforts of the German AML approaches have
been derived from recent Cooperative Group and the M. D.
The rates of acute leukemia cure have gradually improved over the
last decade. Clinical study results reflect the impact of
chemotherapy intensity and duration, the role of prolonged
maintenance, intensified consolidation or very early
intensification. Further progress has also been achieved in bone
marrow trans plantation, and recent prospective studies and
meta-analyses have contributed comparisons of the high antileukemic
efficacy of bone marrow transplantation to that of improved
chemotherapy. This allows a more successful combining of the two
forms of treatment. New prognostic factors have emerged from both
cytogenetic and molecular genetic research. Thus, the Philadelphia
chromosome translocation and the bcr/abl gene rearrangement have
proven to be the dominating risk factor in acute lymphoblastic
leukemia. Since the frequency increases with age, differences in
prognosis between children and adults can be explained. Evaluation
of molecular and immunologic leukemia cell markers has provided a
better understanding of residual leukemia in clinical remission, as
a prognostic factor and in monitoring the effectiveness of the
antileukemic strategy. Recent work on leukemic cell biology has
resulted in novel therapeutic approaches such as terminal
differentiation by all-trans-retinoic acid, modulation of
chemotherapy by hematopoietic growth factors such as GM-CSF and
enhancement of immunologic control by cytokines such as interleukin
2. New antimicrobial drugs and the application of mostly empiric
anti-infectious strategies have helped reducing the therapeutic
risk. Thus, a number of recent achievements have provided us with
new options in the management of patients with acute leukemias."
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