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Important milestones in acute leukemia in 2013

This year marked the occurrence of several important milestones in the treatment of acute leukemias. First, the standard 7 + 3 protocol for acute myeloid leukemia (AML) was developed 40 years ago, and with some adaptations, has stood the test of time. Second, the 1 millionth hematopoietic cell transplant was recorded this year. Stem cell transplant, the first reported by Dr E. Donnall Thomas in 1957, had been considered a rare procedure until about a decade ago. Today, it has become a proven and often life-saving therapy for patients with acute leukemia. Advances in the treatment of patients with AML continue to take place, many of which relate to an increased understanding of the clinical heterogeneity of known subtypes. Forty years ago, the regimen that has come to be known as 7+3 for acute myeloid leukemia (AML) was born [1,2]. Cytosine arabinoside, or arabinosylcytosine as it was then called, was given as a continuous intravenous infusion of 100 mg/m(2) for 7 days, and the anthracycline, daunorubicin, was administered at 45 mg/m(2) intravenously for 3 days. Sixteen patients were originally treated on this protocol, and 5 of 8 previously untreated and 2 of 8 previously treated patients achieved a complete response (CR). This regimen has withstood the test of time. Attempts to add or substitute other agents have not yielded superior results. The only major contemporary change is that a higher dose of daunorubicin is safe and has become the standard of care [3].

Establishment of the Ernest Beutler Memorial Lecture

Although acute leukaemia was not a principal research interest of Ernie’s, he did establish the haematopoietic stem cell transplantation programme at the City of Hope Medical Center in 1975 and recruited Karl Blume to develop it. He and Karl and other colleagues at the City of Hope published one of the early papers establishing the utility of transplantation in first remission for patients with AML [2]. Karl went on to establish the haematopoietic stem cell transplantation programme at Stanford, and his disciples have scattered throughout the land to establish or lead other transplantation programmes. Thus, according to Karl, this made Ernie the father, grandfather and great-grandfather of transplant programmes throughout the United States, a contribution integral to the interests of the attendees of this forum. It is fitting that Drs. Rowe and Tallman have named the keynote lecture in Ernie’s memory. And I am confident that Ernie would be very pleased that Joseph Bertino was the inaugural speaker, a fellow physician-scientist of distinction and accomplishment. Ernie Beutler was the quintessential physician scientist. His knowledge of genetics, biochemistry, molecular biology, nutrition, cell physiology, medicine, haematology and other fields was unparalleled and allowed him to apply his experience and keen insights into a remarkable array of human disorders. There is a German proverb, which translated states: ‘‘Much is known, but unfortunately in different heads.’’ Ernie was an exception to this adage. He had it all in one head, and he had so many other characteristics that made him a great scientist. Two that stood out were that he chose important problems, and he stayed with them. At the time of his death, Ernie was still involved with a malaria