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Ⅰ.LEUKEMIA IN THE PAST 1

Ⅱ.DEFINITION 12

Ⅲ.CLASSIFICATIONS 15

Ⅳ.THE PREVALENCE OF LEUKEMIA 27

Definitions 27

Sources of Information 28

Geographical, Racial and Social Distribution 29

Total Prevalence 31

Type Distribution 31

Age Distribution 36

Sex Distribution 37

Is There a Rising Incidence of Leukemia? 39

Ⅴ.THE ETIOLOGY OF LEUKEMIA 44

The Nature of Leukemia. Is Leukemia Neoplastic? 44

Cytology of Leukemic Cells, 45

Relation of Leukemia to Tumors of the Lymphatic and Hematopoietic Systems, 45

Leukemia in Animals and Its Relation to Neoplastic Disease 47

Other Views on the Nature of Leukemia 50

Infection 51

“Metabolic” or“Toxic” 58

Leukemogenic Factors 62

Heredity， 62

Hormones， 66

Radiation， 66

Benzol, 75

Ⅵ.THE PATHOLOGY OF THE LEUKEMIC CELL 86

Development 80

Morphology 93

Chemistry 99

Carbohydrate Metabolism 105

Life Span of Leukocytes 106

In Vitro Studies of Leukocytes 108

Recapitulation and Outlook 109

Ⅶ.COURSE AND SPECIAL PATHOLOGY AS RELATED TO SYMPTOMATOLOGY 118

Clinical Manifestations 118

The Onset 119

The Early Physical Findings 122

The Further Course 124

Special Pathology and Pathologic Physiology of Leukemia, Particularly in the Later Stages 126

Hematopoietic and Lymphatic Organs 126

Involvement of the Bones and Joints 130

Chloromas 135

Involvement of the Nervous Sys-tem 138

Involvement of the Skin 141

Involvement of the Gastrointes-tinal Tract 143

Involvement of the Heart 145

Involvement of the Mouth and Respiratory System 147

Mikulicz’s Syndrome 149

Involvement of the Retina 149

Involvement of the Kidneys 151

Pria-pism in Leukemia 151

Pregnancy in Leukemia 152

Ⅷ.CLINICAL DESCRIPTIVE FEATURES 159

The Acute Leukemias 159

Symptoms 159

Signs 159

Course 160

Blood and Bone Marrow 161

The Chronic Leukemias 167

Chronic Granulocytic Leukemia 168

Symptoms and Signs, 168

Blood 168

Course 170

Special Symptoms and Complications 171

Other Types of Granulocytic Leukemia 173

Eosinophilic (Granulocytic) 173

Basophilic (Granulocytic) 177

Mast Cell Leukemia 179

Chronic Lymphocytic Leukemia 179

Symptoms and Signs 179

Disorders of the Serum Proteins 186

The Blood Picture 187

Course 188

Multiple Myeloma (Chronic Plasmocytic Leukemia) 189

Pathologic Physiology, 189

Clinical Course, 201

Congenital Leukemia 202

Ⅸ.SPECIAL FEATURES 206

The Anemia 206

The Hemorrhagic State 215

Platelet Disturbances:Thrombocytopenia;“Thrombocytopathy,” 216

Other Factors 216

Certain Metabolic Aspects 218

Purine Metabolism, 219

The Basal Metabolic Rate, 221

Serum Pro-tein Abnormalities 222

Immunologic Abnormalities 226

Auto-immune Hemolytic Anemia 227

Leukocytic Antibodies 228

Platelet Antibodies 229

Ⅹ.DIFFERENTIAL DIAGNOSIS 234

Clinical Diagnosis 234

Laboratory Diagnosis 237

Ⅺ.THE LABORATORY DIAGNOSIS OF LEUKEMIA 243

Examination of the Blood 243

Acute Leukemia 243

Chronic Leukemia 247

Summary of Blood Find-ings 249

Examination of the Bone Marrow 250

Splenic Puncture 253

Examination of the Lymph Nodes (Puncture; Biopsy) 256

An Appraisal of the Relative Value of the Various Hematologic Investigations in Cases of Leukemia 258

Ⅻ. LEUKEMIA AND THE “MYELOPROLIFERATIVE”DISORDERS 262

Chronic Myeloproliferative Disorders 264

Myelosclerosis and Myeloid Metaplasia 264

Polycythemia Vera, and Its Relationships to Myelofibrosis and Leukemia 271

Thrombocythemia 277

The Acute Myeloproliferative Syndromes 278

The Di Guglielmo Syndrome; Relations to Myelosclerosis and to Polycythemia 278

Relationships of Leukemia and Polycythemia Vera to Other Hematologic Conditions 291

Leukemia, Tuberculosis and Carcinomatosis 292

ⅩⅢ.THE PROGNOSIS OF LEUKEMIA 298

Difficulties in Prognosis 298

Ways of Expressing the Prognosis 300

The Over-all Prognosis in Untreated Leukemia 301

The Prognosis in Individual Cases 304

The Influence of Treatment on the Prognosis 306

ⅩⅣ.WHAT SHOULD ONE TELL THE PATIENT! 311

ⅩⅤ.THE TREATMENT OF LEUKEMIA 314

Introductory 314

Mode of Action and Clinical Uses of Therapeutic Agents in Leukemia 318

Ionizing Radiations 319

Mechanism of Action of Ionizing Radiations on the Blood Cells 319

Mode of Therapeutic Action of Ionizing Radiations in Leu-kemia 321

Clinical Use of Ionizing Radiations 325

Chemotherapy 327

The Nitrogen Mustards (Alkylating Agents) 329

Other Alkylating Agents 333

Mustard Derivatives 334

Ethyleneimino Compounds 335

My-leran 336

Clinical Uses of the Alkylating Agents 337

The Colchicine Group 338

Agents with Uncertain Mode of Action 339

Arsenic 340

Benzol 340

Urethane 340

Aromatic Diamidines 342

Others 343

Antivitamins and Antimetabolites 343

Folic Acid Antagonists 345

Purine Antagonists 348

Amino Acid Analogs 350

Clinical Use of Antivitamins and Antimetabolites 351

General Note on the Various Anti-mitotic and Cytostatic Agents 351

Other Forms of Therapy 352

Cortisone and ACTH 352

Symptomatic Therapeutic Agents and Their Clinical Uses 355

Splenectomy 356

No Therapy 356

Summary 356

Management of the Different Forms of Leukemia 371

Acute Leukemia 371

In Childhood 371

In Adults 375

Chronic Leukemia 379

Chronic Granulocytic Leukemia 380

Chronic Lymphocytic Leukemia 388

Multiple Myeloma 393

ⅩⅥ.LEUKEMIA.IN THE FUTURE 398

INDEX 411