Chronic Leukemia
Chronic myelogeneous leukemia (CML) has been the standard disease for treatment with an early allogeneic stem cell transplantation with projected cure rates between 60 to 80% of patients who undergo transplant from an HLA matched sibling. The availability of a new agent, STI 571, which specifically inhibits the enzyme tyrosine kinase caused by the Philadelphia chromosome expands the options in CML. STI and interferon are both effective agents in decreasing the Philadelphia chromosome. Ongoing studies are trying to determine their role in the initial therapy of CML.

Therapy options for chronic lymphocytic leukemia (CLL) are even broader and depend on the age of the patient and stage of the disease. The options range from watchful waiting to chemotherapy of varying intensity and to transplantation in selected patients. There is an ECOG phase III trial (E2997) which randomizes patients between fludarabine vs. fludarabine and cyclophosphamide in previously untreated CLL patients. A new monoclonal antibody, Campath 1h, is under investigation for its use in patients with CLL. CLL patients are also being considered as candidates for the mini allogeneic transplantation.

Lymphomas
Both Hodgkin’s disease (HD) and non-Hodgkin’s lymphoma (NHL) have been primary focuses of the program. For HD we now have three phase III cooperative group trials for the different stages of disease. The first study (JHD06) is for limited stage patients comparing ABVD to ABVD plus radiation therapy; a selected number of patients can be offered radiation therapy alone. The second study (E2496) compares ABVD to a more intensive regimen, Stanford V + radiation in patients with an intermediate prognosis. The final study (S9901) is for patients with poor prognostic features and compares ABVD to ABVD followed by an autologous transplant. There is a similar intergroup trial (S9704) evaluating the role of CHOP + transplantation vs. CHOP in aggressive NHL with poor prognostic factors. Other cooperative group studies (E4494, E1496) and investigator initiated protocols are evaluating the role of monoclonal antibodies and radioimmunotherapy in NHL.

Multiple Myeloma
Vanderbilt was one of the leading institutions which participated in an intergroup study of standard dose versus myeloablative therapy with autologous transplant for previously untreated symptomatic multiple myeloma (S9321). With Dr. Goodman’s efforts, we placed over 10% of the patients on ECOG’s contribution to the study; the results of this study are pending. New evaluations in multiple myeloma include the use of mini-allogeneic transplantation, a phase II trial evaluating gemcitbine/carboplatinum, and a phase I trial evaluating a new antiangiogenesis drug. Myeloma is a disease in which thalidomide has efficacy and ongoing trials of similar drugs are being evaluated.