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Management of the Chronic Leukemias: Special Considerations in the Elderly Patient. Part II: Chronic Granulocytic Leukemia

Several diverse disorders have, for reasons historical rather than scientific, been grouped together as chronic myeloid leukemias (Table 1), [1]. The least rare member of the group is Philadelphia-chromosome-positive chronic granulocytic leukemia (CGL). For this disease, the potential role of biological therapy with interferon, and the likely impact of recent advances in molecular genetics upon its future management, will be explored. Allogeneic bone marrow transplantation is the only known curative therapy for CGL, but in the older person, this treatment currently is proscribed because of lethal toxicity. In the elderly, treatment of CGL is with palliative, not curative, intent. The diseases listed in Table 1 resemble one another in being more or less chronic leukemias that overtly involve the granulopoietic cells of the bone marrow. Cytogenetic, enzymatic, and more recently molecular genetic studies indicate that they represent monoclonal proliferations, originating from a pluripotential hematopoietic stem cell [2]. In sorne cases, the B-celllineage of lymphocytes is also implicated, and there are a few reports of the involvement of T-lymphocytes in the neoplastic clone, indicating that it originated at a truly primordial stem cell level. Clinically, the different chronic myeloid