Improved Outcome for Children with Acute Leukemia: How to Address Global Disparities

Abstract

Modern treatment of childhood acute leukemias started with the use of methotrexate (MTX) by Farber and colleagues in 1948 (reviewed in Dawn of Chemotherapy of Childhood Cancer) (Wolff 1999). The first observations of risk categorizations came in 1949 when Wolf Zuelzer noted that in patients treated with supportive care alone, those with initial white blood cell (WBC) counts of less than 10,000/μL survived longer than those with higher WBC counts (Zuelzer 1949). Subsequently, Dr. Roger Hardisty called attention to a lymphosarcoma variant that is detectable on chest X-ray by the presence of mediastinal enlargement. In 1975, two groups of investigators (from St. Jude Children’s Hospital, Memphis and Children’s Hospital of Michigan, Detroit) simultaneously showed that the so-called lymphosarcoma variant is of T-cell lineage (Ravindranath et al. 1975; Sen and Borella 1975), and in 1978 Secker-Walker, Lawler, and Hardisty (Secker-Walker et al. 1978) showed the critical importance of cytogenetics in childhood common acute lymphoblastic leukemia (ALL). Shortly thereafter, immunophenotyping and cytogenetic evaluation of childhood ALL became a standard practice.