The M.D. Anderson Cancer Center experience with interferon-alpha therapy in chronic myelogenous leukaemia

The M.D. Anderson Cancer Center (MDACC) clinical experience with interferon-alpha (IFN-alpha) therapy in chronic myelogenous leukaemia (CML) spans a period of approximately 15 years, Multiple, single-arm studies and a handful of randomized studies comparing IFN-alpha with conventional chemotherapies have been completed during this period. Information on the types of response and durability of responses provides us with a clear sense of the scope of IFN-alpha activity in this disease and the impact of disease characteristics on therapy outcome. Nevertheless, several issues are still subject to intensive debate such as optimal therapeutic dose, duration of therapy, appropriate therapeutic decisions in CML (choices between IFN-alpha therapy and allogeneic bone marrow transplant) and the advantage or lack thereof of combination therapies. The seemingly 'settled' issues and the 'unsettled' ones are the subject of this chapter, and they will be discussed from the MDACC perspective. Furthermore, despite the fact that IFN-alpha has been studied extensively, its mode of action in CML is still very much a subject of speculation. Possible modes of action will also be a subject for discussion in this chapter.