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An autopsy study of 1206 acute and chronic leukemias (1958 to 1982)
Insights
Autopsy findings reveal declining leukemia cell presence in patients over time. Improvements in acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL) treatment led to reduced organ involvement, unlike chronic leukemias.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Leukemia diagnosis and treatment have evolved significantly.
- Understanding autopsy findings provides insights into disease progression and treatment efficacy.
Purpose of the Study:
- To analyze trends in autopsy findings for four major leukemia types.
- To assess changes in organ involvement over time in acute myeloid leukemia (AML), chronic granulocytic leukemia (CGL), acute lymphocytic leukemia (ALL), and chronic lymphocytic leukemia (CLL).
Main Methods:
- Retrospective review of autopsy data from 1,206 patients.
- Data collected between 1958 and 1982.
- Analysis of anatomic site involvement for AML, CGL, ALL, and CLL.
Main Results:
- Significant uniform decrease in residual AML at autopsy sites throughout the study period.
- Decreases in CGL and ALL involvement noted since 1976 and 1978, respectively; no significant decrease for CLL.
- Reduced extramedullary site involvement observed for AML, CGL, and ALL over time.
- Specific organ predilections noted for ALL (testes, leptomeninges) and CLL (lymphoreticular organs, kidneys).
- AML and ALL showed significant decreases in organ involvement, suggesting improved therapeutic efficacy, particularly CNS prophylaxis for ALL.
Conclusions:
- Therapeutic advancements have led to reduced leukemic cell burden and organ infiltration in AML and ALL.
- Chronic leukemias (CGL, CLL) showed less significant changes in organ involvement patterns.
- Central nervous system prophylaxis likely contributed to decreased meningeal involvement in ALL.
Abstract:
Autopsy data on 1,206 children and adult patients with acute myelocytic leukemia (AML) (585), chronic granulocytic leukemia (CGL) (204), acute lymphocytic leukemia (ALL) (308), and chronic lymphocytic leukemia (CLL) (109) obtained from 1958 to 1982 were reviewed. This analysis has shown that, whereas the proportion of patients with residual AML at any anatomic site decreased significantly and uniformly over the entire study period, significant corresponding decreases in patients with CGL and ALL occurred only since 1976 and 1978, respectively. No significant corresponding decreases were noted in patients with CLL at any time. Significant decreases were also noted over time in the rates of extramedullary site involvement by AML, CGL, and ALL. Whereas the lymphoreticular organs, kidneys, adrenals, and pituitary were most often involved at autopsy by CLL, the testes, leptomeninges, dura mater, uterus, large bowel, and pancreas were most often involved by ALL. In general, patients with AML and CGL showed the lowest relative rates of involvement of the various organs by leukemia during the 24-year period. Whereas patients with AML and ALL showed significant decreases in the rates of involvement of nearly all anatomic sites during the most recent study periods, those with CGL and CLL showed corresponding decreases in only a few organ sites. The lower rates of organ involvement in patients with AML and ALL attest to the more aggressive eradication of leukemic cells by therapeutic regimens in these diseases over time. In particular, the significant decrease in the rate of meningeal involvement by ALL during the most recent period is probably attributable to central nervous system prophylaxis.