History of Pediatric Hematology Oncology

Abstract

The following article is the second in this series. Dr. Pearson provides a colorful account of the history of pediatric hematology and oncology and of the pioneers in these fields. He also describes the studies that led to many of the great achievements in medicine, such as the cure of leukemia, the prevention of Rh disease and the understanding and treatment of the hemophilias and hemoglobinopathies. Alvin Zipursky Editor-in-Chief History of Pediatric Hematology Oncology HOWARD A. PEARSON Yale University School of Medicine, New Haven, ConnecticutPediatric Hematology Oncology as a specialty was possible because of the evolution of the science of Hematology, which developed microscopy for describing blood cell morphology and methods for quantitation of these elements. Before pediatric blood diseases could be defined, it was necessary to establish the normal blood values of infancy and childhood. The unique features of the blood of the newborn were the focus of many of the early studies. After normal values were established, specific blood disease and hematologic syndromes of children began to be described in Europe and the United States. Pediatric Hematology Oncology is a broad and complex area that encompasses perturbations of the several-formed elements of the blood and their precursors in the bone marrow, as well as the coagulationfibrinolytic systems in the plasma, the reticuloendothelial system, and malignancies of the blood and solid tissues and organs. The interactions of the blood and nutrition have long been important areas of study. Advances in Pediatric Oncology have been particularly spectacular in the last 50 years. Using multi-modal therapy including combination chemotherapy, more than 80% of children with cancer can now be cured. During the last 50 years, Pediatric Hematology Oncology has increasingly used tools of the "new biology": immunology, biochemistry, enzymology, genetics and molecular genetics, and others. During the last century, many diseases have been recognized and defined by biochemical and genetic mechanisms, and in some instances they have been prevented or cured. The hematology oncology of infancy and childhood is a relatively recent area of study whose development depended upon the evolution of the science of Hematology and, especially, upon methods to study the blood and its elements. As Wintrobe has pointed out, the development of the field of Hematology has been driven by technology. He divided the early evolution of Hematology into two general areas: morphology, which relied on the development of microscopy and quantitation of the elements of the blood, which came later (1).The invention of the microscope enabled identification of the blood cells. Antonj van Leeuwenhoek working in Delft, Holland, constructed a primitive microscope from a minute biconcave lens mounted between two metal plates attached to a screw that permitted focusing. Leeuwenhoek's publication in 1674 contained the first accurate description of the red blood corpuscles (2): The blood is composed of exceedingl...

Características clínicas odontológicas de pacientes niños bajo tratamiento oncológico.

“…O incluso más bajos para pacientes que se encontraban en control después de la quimioterapia que mostraban valores de 4,5 y 17,01 (SD, 9,14, respectivamente) [21][22][23][24][25][26][27] . Por el contrario, en piezas temporales de los pacientes de este estudio, encontramos índices de caries más altos: 5,43 en otros cáncer y de 5,17 en LLA, en contraposición a la literatura que muestra ceo general para los pacientes que han recibido terapia antineoplásica independientemente de su modalidad 3,20,23 . Los valores de CPO o ceo variaron significativamente en los niños que padecían LLA, no así en los que presentaban otros tipos de cánceres diferente a LLA.…”

“…El cáncer es una enfermedad poco frecuente en niños menores de 15 años. Sin embargo, desde la década del '80 es la primera causa de muerte en los niños mayores de 5 años, precedida sólo por los accidentes de diversa índole, tanto en países de Europa y Estados Unidos, como en Chile [1][2][3] . El cáncer infantil constituye un grupo heterogéneo de enfermedades oncológicas con etiología, diagnóstico y pronóstico muy variable.…”

Mortalidad por cáncer infantil en Chile: Modelo de transición epidemiológica en la infancia

“…La década de 1960 coincide con los años inmediatamente posteriores a la creación del Servicio Nacional de Salud (1952) 11 , cuyo accionar posibilitó una mayor cobertura de salud, coordina- ción y resolutividad, aumentando progresivamente la capacidad diagnóstica de tumores malignos. Sin embargo, la sobrevida a largo plazo del conjunto de cánceres infantiles en países desarrollados alcanzaba un 20%, siendo para la leucemia linfoblástica aguda (LLA) -el cáncer más común de la infancia-apenas un 5% 12 . La creación de las primeras unidades de oncología infantil del sistema público (1968) y la formación de hemato-oncólogos infantiles (1969) contribuyó al descenso de la tasa de mortalidad.…”

Principles of Medical Oncology

“…Informal training was available by the early 1960s, but medical oncology was only recognized as a new subspecialty of Internal Medicine in 1972 1 and pediatrics in 1974. 2 Modern drug treatment of cancer dates to World War II when Gilman and colleagues launched the first clinical trials of nitrogen mustard. Since then, over one hundred different drugs have been approved in the United States for the treatment of cancer.…”