Riddle: what do aplastic anemia, acute promyelocytic leukemia, and chronic myeloid leukemia have in common?

Leukemia
R A Brodsky, R J Jones

Abstract

Secondary myelodysplastic syndrome (MDS)/acute leukemia frequently evolves from severe aplastic anemia (SAA) following immunosuppressive therapy. Secondary clonal cytogenetic abnormalities have now been reported after noncytotoxic therapy in two additional settings: all trans retinoic acid (ATRA) treatment of acute promyelocytic leukemia (APL) and imatinib for chronic myeloid leukemia (CML). We propose that SAA, APL, CML, and MDS represent different manifestations of generalized insults to the bone marrow. In SAA, the insult to hematopoietic progenitors leads to an immune attack, while in APL, CML, and MDS, it gives rise to the malignant clones. A primary insult to bone marrow could simultaneously lead to several abnormal hematopoietic cell clones, with one dominating and the others present but below the level of detection. Such a 'field leukemogenic effect' would be analogous to the 'field cancerization effect' described in solid tumors. Nonspecific cytotoxic therapies, including antileukemic chemotherapy and allogeneic transplantation, have broad activity that could inhibit both the overt disease and other undetectable coexistent abnormal clones. In contrast, disease-specific targeted therapy such as immunosuppressive therapy...Continue Reading

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Citations

May 12, 2005·Lancet·Robert A Brodsky, Richard J Jones
Nov 30, 2011·Bioconjugate Chemistry·Annalisa GuaragnaGiovanni Palumbo
Nov 24, 2012·Nature Reviews. Cancer·Nicola J Curtin
Jun 3, 2009·Nature Reviews. Clinical Oncology·Lisa PleyerRichard Greil
Mar 17, 2007·Cancer Cell International·Gabriel D DakuboRyan L Parr
Feb 21, 2014·Indian Journal of Hematology & Blood Transfusion : an Official Journal of Indian Society of Hematology and Blood Transfusion·Rajeshwari Satish HandigundSuvarna Inumella
Apr 3, 2014·The Journal of Clinical Investigation·G Paolo Dotto
Sep 23, 2008·European Archives of Oto-rhino-laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery·Rubén Cabanillas, José L Llorente
Oct 7, 2009·American Journal of Hematology·Crisoula BatziosLynda J Campbell
Aug 23, 2005·Cancer Chemotherapy and Biological Response Modifiers·Peter H Wiernik
Apr 10, 2010·Blood·Jerry L Spivak
May 20, 2006·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Antonio C WolffVered Stearns

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