Leukemia

The following program is produced by the University of Michigan broadcasting service under a grant in

aid from the National Educational Television and Radio Center in cooperation with the National

Association of educational broadcasters lukemia.

A program from the series human behaviors social and medical research

produced by the University of Michigan Broadcasting Service. These

programs have been developed from interviews with men and women who have the too often

unglamorous job of basic research. Research in medicine in the

physical sciences social sciences and the behavioral sciences

vocational you will hear what may seem like a strange or an unfamiliar solve.

These are the sounds of the participants all of it is laboratory or his clinic

where the interviews were first conducted. The people you will hear today

are Dr. Joseph Hill director of the widely Research Institute in Dallas Texas.

And remarks by Dr. John Enders of Harvard University and Dr.

John Givens Jr. of the Jefferson Medical College in Philadelphia.

And my name is Glenn Philips leukemia or you may have

heard lupus I think leukemia or Lou Cosas

the mention of the word strikes fear. What is it. What are the chances of a

cure. What are the present trends in research on the disease and what research

approaches may prove valuable perhaps in the next half hour these questions can be at

least partially answered. The late Dr. Frank Bethel of the University of

Michigan defines leukemia this way. Leukemia is a fatal

disease considered by many to be neo plastic. That is an abnormal

growth which arises primarily in the blood forming organs and is characterized

by an extensive and abnormal proliferation of the white blood cells and their

precursors with infiltration into the various tissues of the body especially in the

bone marrow spleen and lymph nodes. Almost invariably at some

time during the disease immature white blood corpuscles appear in the circulating

blood frequently in great numbers. In most cases it is

associated with anemia often of a severe degree. To

illustrate the growth of abnormal cells. Picture if you will a cubic millimeter of

blood normally in the human body. There are about seventy five

hundred white blood cells in this area. Leukemia. The number

increases to as high as 1 million white blood cells in the same area.

I asked Dr. Joseph Hale if there are different forms of this disease.

I think perhaps the two most interesting forms as far as the public is concerned is rather cute or

chronic because the disease disease behaves very differently. In the

chronic and some forms of may live up to 20 years or more in the acute for if you

live beyond the year and a half. However we can also divide them according

to the type of cell involved. Since leukemia seems to be a type of malignant

disease where there's an excessive.

Preparation of one kind of blood cell involves only one kind of say a

type that can be the lymph aside or the grain of the site and so for us.

So it can be classified in two ways chronic or acute into the common

blood cell types.

In answer to the question are the incidences of leukemia on the increase or

decrease.

Dr. Hill said This question is one which is very difficult to answer

because of the fact that diagnosis may be more accurate. People

may be more aware of the disease. In my personal experience for example

would not be a criterion because whenever you start to work in some particular way it may attract patients

from farther away. Most of us however think that is on the increase.

And to me one of the most significant conversations I've had in this regard is with the

pathologist from New Zealand who happened to see all of the

diagnostic slides of all the leukemia is in the island for about the last 20 years.

This is Dr. Staveley and he said he felt he could diagnosis accurately 20 years ago as he

could today and no reason why this shouldn't be true. And he feels that there is an

increase. However this require a lot more study and careful statistical

analyses in our National Institutes of Health are doing this now.

Dr. Hill feels the cases of leukemia are on the increase. I asked him what he

attributed this.

And I have asked the tough question because immediately bring up the question of what causes leukemia

and of course the ultimate answer this is all known but

we like to think of these things rather loosely as perhaps a chemical civilization catching up with us.

And not just chemical but chemical and physical. And

since we know there are at least five factors that more or less certainly have

something to do with the causation of malignant disease and I'm including leukemia as a

special form under this. We know that our genes are hereditary

Constitution our own chemistry has something to do with it because certainly in

animals there can be strains of our bread that have a high incidence

of leukemia. Secondly we know that hormones have something to do with it. This may simply be

another way of saying our inheritance again because our hormonal make up depends our horizons.

Certainly chemicals have something to do with the causation of cancer this was the earliest thing that was

proved. And of course everyone knows from reading the newspapers a little bit of radiation is going to

cause cancer and all this and then finally viruses which at the

moment is perhaps the most active topic in this connection. Well

you can take your pick here because you can say that today.

There are lots of things that bear on the problem certainly there's a question of radiation.

More and more radiation. Personally I don't think this is important to some people make

out because of the heavy radiation that can be associated with a

causational Keamy is not the type of thing that the ordinary citizens are receiving.

Certainly we get all sorts of chemicals in the air in our foods and every other way. But it's

difficult to tie this in with the known chemicals that are potent cancer causes

and so on. Whether there are new forms of virus developing you know this is a possibility

perhaps we control the bacteria so well that maybe the viruses have a little better chance to get going.

Two questions immediately suggest themselves from that answer. The first is an interesting

speculation. Dr. Hill said perhaps our civilization is catching up with us.

Other statements from people who said that in some of the other countries where living standards were lower

many of the diseases baffling American scientists do not occur or occur in a

much lesser extent.

Dr. Neil's comment was Well actually this is an awfully interesting question.

I rather think that this is hardly worth the price too.

Will be able to resist some of these diseases by reverting to

primitive ways of living and that of the some truth and that's because

in very primitive societies we know that some viral diseases seem to have a

very low incidence. The contrary may actually be true in that in these

societies they may have the viral diseases so early in life that they

develop immunity and the bad cases die and the

population may not even be aware that the disease is common I think undoubtedly there's a good deal of truth in

this.

The second question I referred to was on the subject of radiation. My

question to him once. Isn't it true that radiation is not in every case harmful.

His answer was a little booby traps in this one.

There are those who say it is that any amount of radiation is harmful and it's just a question of the more you

get the more harmful it is. I don't think this has been proved however.

And we know that radiation in many various ways such as

taking X-ray pictures helping a diagnosis using it for therapy and so on has been

a great lifesaver. And I'd hate to see the public become so fearful

of radiation in various helpful forms of medicine that they would fear to have it.

And the thing that I am crying is the tendency to

be fearful of amounts of radiation for example that would be represented the difference say in

living in a wooden house or a brick house or changing the altitude at which you live say from sea

level to a thousand feet or even the move to Denver a mile up. These

differences in radiation are often greater than the differences that we have been

talking about Dr. Neil also mentioned an association between

leukemia and the virus.

And he further commented on this possibility.

This depends on what you're talking about animals or humans. There's a great deal of evidence in animals.

And indeed it is possible to induce leukemia.

And animals apparently with a virus suspension of self free material.

It is also possible to increase the incidence of leukemia

and animals that are normally resistant to it by using techniques such as Dr. Gross of New

York City did where he gave the virus to the new

born mouse. And in a resistant

strain some months later. These

mice a large percentage of these mice would develop leukemia whereas the mature

mouse was quite resistant to the development of leukemia. So we have

to regard experiments of this type as having a good deal of significance. We must

run however that when we speak of viruses causing leukemia we're certainly

not speaking in terms of the usual direct relationship of a virus to a disease

because in the for example in these mice I mentioned the virus is given at birth. And

yet a good fraction of the mouse's lifetime later they develop the disease. So there's something

different here.

Dr. John Enders of Harvard University and one of the world's foremost authorities

on the viruses added this about the association between leukemia and the

virus and the definite possibility that me may be in a

kid with leukemia.

Should these non-normal a number of different who came here as you might

caused by a viral agent in the case have been

several lightish been

known for a long time in a variety of

of the in several it indeed I caused by

different viral agents. For example St. Louis and

several like the Japanese readership allied to

make wine and shit for all my lighters

and several likeness of horseshoes free curry were used in fixtures for man.

All the others.

Known to be caused by Agent

Dr. Healy is intimately concerned with research on leukemia and he

enumerated his interest this way.

Yes our research revolves around the

patient in the sense that the problem starts here and the solutions if any are attempted solutions

must end here. At. The same time. Research is a tool like ours

operates by having a sort of a vertical type or research so to speak. Extending from

molecules to man. This means then that we might classify

approach and two types. One the direct attempts on the disease

itself through experimental therapy. And secondly

analytical approaches that vary all the way from very

careful study of the different kinds of molecules in the blood and in the cells

on up to electron micrograph studies leukemia cell searching for the virus.

I asked Dr. Hill if he could be given the answer to one question about leukemia.

What would that one question be.

Well of course this is just a leading question I realize obviously there could be only

one answer this but it would be up to much discussion that would be to find a cure for it.

Scientifically one would be most intrigued by the cause because you can usually get a cure but if

I had one wish so to speak give me the cure because that's the thing we're trying to do is

to find a cure so that we can give the public relief from this disease.

However let me assume that you want me to go into something

further along this line of my own wishes.

One of the questions that intrigues me most is the question of why are

tissues are so individual and why we cannot accept grafts one from another

except identical twins.

And yet why the fetal animal. Can

accept the graft cells from

another animal such as for example a non identical twin before

birth.

This is one of the great mysteries if we knew all about this this might give us

a wonderful point from which to start to attempt to cure this disease. And

indeed some of our recent work has been along this line

as many centers in the world have tried to

transplant Mau Mau from a normal well

human into a sick leukemia human in whom the bone

marrow has been destroyed by intensive radiation.

Unfortunately we do not know of any actual cures yet of

leukemia but this is potentially a realm of courses based on earlier work with

animals where it was discovered that. It was

possible to transplant tissue such as bone marrow for one mouse to another

mouse not an identical twin. Or. The

genetic equivalent of a homogeneous strain of mice. And the

reason this could be done was because a sufficiently large dose of radiation was

administered to the mouse receiving such no a sufficiently large dose to

knock out the immune mechanism and destroy the recipient's mouth.

This animal then if not further treated would die in other words a lethal dose of

radiation. Now if such an animal after the radiation is given a

large number of cells from the mouth of another mouse under

these conditions it will take and the mouse can sustain life on

another animal cell. This caused a great deal of excitement and

hope in the field of leukemia and the hard work along this line and further

attempts. To do it in the human have not to date been entirely

successful.

It is true that in Yugoslavia when they had a big reactor reactor accident

Dr. Metcalf perished apparently tired of these people or

marrow transplantation. But apparently today they have reverted

back to their own cell types and therefore it was not a permanent transplant

such as you would need if you were to hope to cure leukemia by this means.

And our own institute we have been interested in attempting this not using X or

radiation which gives a radiation evenly all over the body

perhaps a little more on the surface. But rather by using radioisotopes

of colloidal type injected into the vein. Which

because of the colossal nature that means little tiny part particles too small for the microscope to see

are concentrated in certain organs. The very organs where this

disease is concentrated. And by giving a lethal or near a lethal

dose of radiation in this manner then following on with

attempted following with large doses is nearly compatible human

error is possible. We had hoped that this might be a rational

approach. Quite obviously certain limitations would be involved

in doing such a thing. One will have to work with a terminal of QI mix.

Which is not the most favorable time to do it. We have attempted

this. To date without success. But with some

results that are promising and I am not yet convinced that this

possible route has been fully explored.

We have had to drop the experimental work of the radioisotopes and attempts at

transportation but have gone on to do a replant

ation of the patient's own marrow not only in leukemia but also in terminal cancers of various

types. It works something like this if the patients mare was not involved

as in a terminal cancer may not be. Or in the case of a leukemia when they're in the

first remission then the bone marrow appears to be normal. You take

a large sample of this mare by several needle punctures under anesthesia from the

large hip bone. This is first frozen under special

conditions so that the sides remain alive and is

preserved at the temperature of liquid nitrogen. Summers are around 200 degrees

below zero. Under these conditions the bone marrow cells can be kept

alive like seeds and used for replanting later.

Having such mouthbreather right as of something like insurance and you can then treat the patient

with a degree of vigor and with larger doses

than would otherwise be possible because most of the treatments that will kill the cancer cells

will answer kill and depress the bone marrow cells in the past

has been one of the limitations of chemotherapy or radiation therapy and any

malignant disease. Largely freed from this restriction we can now approach

dosages of chemical agents or radiation or anal

metabolize. Here's a far considered far too dangerous to use.

We are working with this technique then today and

attempting to. Two I hesitate to say curate

attempting to get much longer remissions in leukemia by

getting the patient into remission by a standard technique such as an the

metabolites or hormones starring their marrow while they're in this

apparently normal state. And then instead of merely

withdrawing the treatment or maintaining it and waiting for it to fail and the disease to come

back we then go ahead and give many times the ordinary dosage.

Whatever modality of treatment we're using helping this writer that we might

actually either get a very much longer remissions or are just possibly cured by

such a technique. You know in my case. Where some of the

strains of leukemia may actually be weaker not exactly comparable with human leukemia some

cures have been affected or many years ago by such techniques.

DR JOHN Gibbon Jr. explained the technique of extracting bone marrow from the human

body.

In large amounts and give it about

fat and cells.

If you're going to give it intravenously can be given.

You're going to ask right out of the breastbone by putting a needle through the outer

hard played about and just with strong suction getting bone marrow out this

is a routine procedure to study but don't hurt me more than a

hypodermic needle.

That in the massive cases where we have

had donors come in and give a read

you don't.

You can take a read out from some individual leave the skin of the Red Berets called Perry

Osteen and the rebel reform it's not as nice to look anywhere but

you don't notice it yourself you just saw the chest cage you had before

and then not red and split up under style condition and the mouth

taken out of it so you get a quite a large quantity. And that is given to some of

these people who have had to have.

Ex try to control our use of a growth of blood cells and the

x ray may be so successful in controlling the overgrowth that it makes

them and they make good they don't produce enough white cells or something and then you give them this normal bone

marrow.

Going back to Dr. Hill I asked him where he felt the progress of research has brought us at the

present time in the area of leukemia. His answer hold out much hope.

But at the same time gives a warning to his own profession.

Of course this is a question that's so important. And

even those of us who are working minimally with the problem. Of. Meeting with our

colleagues and hearing interesting programs. Can't answer

this.

It could be tomorrow or could be next century.

Of course one has a right to give opinions I feel or something's bound to give in the next 10 years.

I like to feel that we get it in our time. Certainly the amount of

time and effort. And money being expended in this area is greater

than ever before. My only fear is that too many

of us may be working in the same area. Lead becomes popular chemotherapy for

example is the thing that most of the money is being spent on today and I think this is necessary

because it to date has been the best way of treating the Kenyan's and yet screening

forty or fifty thousand American pounds a year. We haven't come up with anything that

is curative yet and this program has been going on a long time. I think it must continue the

answer may still lie in this direction. But I do hope that we don't just go down the

same road together but that. People try to turn out new ideas new

concepts. And rough and crude as it may sound.

The immunological approach and this transplantation approach I feel has not yet

been fully exhausted. And the other hand the virus story is of a great

deal of interest today and those of us who are working with electron microscopes are seeing regular

bodies in the cells of leukemia tissues that look like

viruses that the size of viruses or the shape of viruses. But of course we can't prove

that an individual little sphere is a virus. This

Rouse is of interest and if we can succeed in

freeing such viruses or particles and then by chemical type-A techniques

concentrating them. And proving their viruses and getting a test system

in animals this is the type of thing we need but this is just the type of thing that isn't worked

out yet. We're just on the verge of many of these techniques. Raji had made very rapid

advances and I hope that this time we can prove or

disprove definitely whether they play a role in human leukemia.

There is no question that research in technological areas has taken giant strides toward

solving mysteries of our world. Almost every day we can hear or see on

radio and television all read in the newspapers of some concrete example as man heads

into the uncharted realm of space. This is not true in medical and social research.

Why we might ask. It is possible only to speculate on an answer.

One speculation is that the public themselves will support research if there is something

material and tangible to see immediately whether as some have said they

can see it ascend skyward to success or meet temporary failure before leaving the

launching pad. The payoffs in medical research are not so material.

Here the great achievement yield dividends in lives saved and happier and healthier lives.

In normal healthy growing children. I asked Dr. heel whether he agreed with the

theory that a lack of public support was produced by materialism.

He said Oh yes I think it is. Let me say that I think it's up to us to

try to show the concrete results. For example at our last meeting of our board of

trustees when I was attempting to challenge them to get out and help more with the

supports We showed them a little child. Who has had acute

leukemia now almost four years and has been perfectly well during this time has grown

norms of the school and so on. On previous occasion I showed them two boys in the

teams would run athletic trophies although they have acute leukemia. I think these are the type of

concrete results that we can use to show people

that something is being done. Actually previously prior to the era

of chemotherapy in modern therapy these children all have been dead probably in less than a year.

The surest and most direct means of reaching the public is through the medium of communication.

I asked Dr. Hill but the communication media could do to help.

Support is of vital importance. For those doing

research in this area. By support I'm thinking particularly local

support local farms. And local enthusiasm and help in various

ways.

For example our institution the relatives of friends the parents of

leukemia children. Without our requesting them and banded

together to help. Through an association to carry education and appeals for

funds in this type of thing for our institution. The

really great advances sometimes in research are achieved by.

By investing funds in long shots by reaching out into the

unknown. It's true there are lots of funds available for research and I think our federal

government is doing a wonderful job in in making funds available in this

manner for research projects. But let the institutions need

funds of their own local farms that can be used as sort of the cement to

keep the structure together. Because. Research grants on specific

projects and to obtain more must outline the project have

a very very rational idea. Rather concrete ideas on how to

carry out the experiments and so on. There are however better

fronts of progress that we must make setting up whole new departments and so on.

One must have funds for and so this type of support I think is the most important thing the

communication medium can and list for the various institutions in the country.

Once reaching the public however appeals are useless if they fall on deaf ears Dr.

Hill voiced his opinions about the apathy of American people.

Well of course as I was a tens if think it can't happen to me. On the other hand I can give you

some concrete examples of the public reaction has been most heartwarming.

The first example I happen to think of doesn't relate directly to leukemia but our

chemists have been searching for a molecule in the blood that has to do with one phase of the clotting

mechanism of course is important to look email because haemorrhage is one of the symptoms of this disease and one of the

cause of death. But in order to carry on this right it was necessary to have a very

large quantity of human blood. And one of the suburbs of Dallas and being

made aware of this problem. Volunteered one hundred four pints

and gave one hundred four pints of human blood to be used for another purpose and research I think this is a

remarkable tribute to the public's ability to understand and to act

in leukemia research.

There may be hope in the not too distant future if Dr. Healy is correct. He said he looked

for some breakthrough perhaps within the next decade but continued public support

and patients are needed. Next week you will hear Dr. Francis

Forester of the University of Wisconsin Dr. Hans Reese also the

University of Wisconsin's Medical School professor Roger Williams of the University of

Texas and Dr. J Morrison Brady the medical director of the Muscular

Dystrophy Association of America Incorporated as they discuss

neurological and muscular diseases. On the next program from the series

human behavior social and medical research Glen Philip speaking

asking that you join us next week and thanking you for being with us at this time.

This program has been produced by the University of Michigan broadcasting service under a grant in

aid from the National Educational Television and Radio Center in cooperation with the National

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Network.