Sometimes Bold Predictions Do Come True: The Lesson Of Chronic Myeloid Leukemia

Perhaps more than most, doctors struggle with memories that mark sad moments in their careers. For me, one of the most indelible was about a wonderful young man with chronic myeloid leukemia (CML).

When I started my oncology career in the early 1970’s, CML was almost always fatal. It would start with a chronic phase which was treated with pretty simple medications. But those medications didn’t cure the disease.

The “almost always” scenario with CML was that several years on, it would morph into an acute phase, or “blast crisis,” that almost always ended in an untimely and frequently very premature death.

I came into contact with this young man just as he was diagnosed with CML. A couple of years later, he entered that acute phase. Rather than face the rigors of intensive chemotherapy, a regimen that was almost always futile, he took his own life. Moments like that live with us forever.

Decades later, (2003 to be exact) a prominent oncologist—who at the time was the director of the National Cancer Institute—made an audacious promise. Andrew von Eschenbach said that by 2015 we would end the suffering and death from cancer and convert it to a chronic disease, much like hypertension and diabetes.

That prediction generated a lot of comments—some positive, many not so positive. But as it turns out, progress against CML, the disease whose prognosis was so bad as to make a young man choose a premature death those few decades ago, is the case study that shows Dr. von Eschenbach’s vision was not as far-fetched as some have come to believe.

A report in the current issue of the Journal of Clinical Oncology from Swedish researchers reviewed the records of all patients 50 and over diagnosed in Sweden with CML between January 1973 and December 2013. They then compared their survival at different periods of time with that of the general population in Sweden.

The researchers report that beginning in 1990, life expectancy began to creep up among CML patients in every age group, even in those diagnosed at age 85. The key result of their report: life expectancy “in 2013 approached that of the general population.”

In practical terms, the authors explain that a 55-year-old male diagnosed with CML in 1980 would have 3.5 years of life remaining, while if that same 55-year-old gentleman was diagnosed in 2010 he would have 27.3 years of life remaining. Even 85-year-old people saw their lives extended: an 85-year-old male diagnosed in 1980 would live about 9 to 10 months after diagnosis, while if diagnosed in 2010he would live more than four years.

One would assume that almost all of this improvement was due to a targeted therapy called imatinib, introduced at the beginning of this century. Imatinib did lead to improved survival, but in fact some of that improvement was actually seen beginning in 1990 well before that drug became available. And now, with yet more targeted therapies available to treat CML, we are able to provide effective treatments to many of those who either don’t respond to imatinib or become resistant to it.

This is in human terms a very dramatic story.

Yes, there are side effects to these drugs and treatments including an increase in cardiovascular disease and perhaps an increase in the number of other cancers.

But for me, the enduring message is that perhaps that audacious, oft-ridiculed prediction that we could cure cancer by 2015 had more validity that we recognize. With CML and for some other cancers, we are indeed turning cancer into a chronic disease for some patients. CML has led the way in this development. And even if it is a relatively uncommon cancer, seeing the enormous progress we’ve made in CML in just the past 15 years should give us the will to continue to strive for similar progress for many more.

This progress came too late for that patient I now remember from some forty years ago, and for countless others. It is in honor of their memory that we should never give up on our goal; we should never abandon hope. Because for the thousands of people diagnosed with CML who’ve benefitted from the advances of the past decade, that doctor was right on target. They are the living proof.

3 thoughts on “Sometimes Bold Predictions Do Come True: The Lesson Of Chronic Myeloid Leukemia

  1. First time visitor.. interesting. Whether or not huge advances are made in research, I really wonder how many people can afford the future cure. Seems you don’t discuss cost vs benefit for an average family. Seems fact is, if one of 4 family members is going thru cancer treatments, the cancered person will die after a lot of costly chemo, etc, and thereafter the remaining 3 members will be debt the rest of their lives. Whats the point of prolonging one life, and other 3 love ones struggle thereafter? I kinda agree with the guy who took his life, even though his reason was pain, not cost to family. As an aside, did you take a poll of docs at the Chicago conference, how many have $1 million + homes? How many of their patients have the same? Billions for cancer research.. zero to families trying to pay for it. Regards

    1. As with all serious and potentially terminal diseases, without advanced medical care, we would face lifespans in our 30s and 40s, rather than 70s and 80s. Almost not enough time to see children and grandchildren raised, to advance education, and to enjoy our accomplishments in life. It is a gift that humankind (most of it anyway) values life so much that striving for a long and healthy life is our goal. Some creatures ignore the fallen, as they suffer and die. It is in human nature to try to help. There is a price tag on medical care, because we live in a civilization where we must work for a living. There are also people who are not able or mentally capable of obtaining a medical education. Education is costly and so is medical research. The debt a doctor pays for a medical education is astronomical and even though it appears they live well, the cost and stress of achieving such a level is huge. Looking at these issues is done for all of society, not just an insular family of three or four. And the value of a doctor’s home and possessions and net worth isn’t part of the equation. Striving for a relatively long life for as long as possible is part of our lives. And pay back may be a consideration. We are given more years to do beneficial things. That may be a good goal to pay back society for a healthier life. This was written by someone who is not and never has been in the medical profession. Dr. Len’s blog is insightful, sensitive, and on point.

  2. One is for sure and really accurate: prevention is better than cure always. Regardless of the advantages of research, proper lifestyle and healthy living is still the number one priority for all of us.

Leave a Reply

Your email address will not be published. Required fields are marked *