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Haematology is a field of Medicine that encompasses the diagnosis and clinical management of blood disorders (neoplastic and non-neoplastic), laboratory measurement of cellular components of blood, proper use and provision of blood products for transfusion, and laboratory investigation and clinical management of disturbances in haemostasis
One could argue that Haematology is the only specialty that is both clinical and laboratory, and requires both diagnostic and therapeutic skills. Haematology is also a model of translational research implementation.
Each year, approximately 1,400 new cases of leukemia and 2,000 new cases of lymphoma are being diagnosed in Greece. These diseases can be classified in many subcategories, and differ from each other with regard to the clinical outcome and therapeutic approaches. Leukemias arise usually from the bone marrow, while lymphomas from the lymph nodes. In contrast to solid tumors, blood cancers require treatment modalities with prolonged hospitalization, appear to be more sensitive to treatment interventions, and especially to targeted therapy, allowing the possibility of cure even in cases where the disease is extensive at diagnosis. The four most common types of leukemias are acute myeloid leukemia, acute lymphoblastic leukemia, chronic lymphocytic leukemia and chronic myeloid leukemia. The differences among them are based on the origin of the neoplastic cells (myeloid vs lymphoid) and the speed of disease progression, if left untreated. The main subtypes of lymphomas are Hodgkin’s Lymphoma and Non Hodgkin’s Lymphomas (NHL), which are further distinguished to B-NHL and T-NHL, depending whether they arise from B or T lymphocytes.
Over the last decade, a significant progress has been made in the understanding of the biology and the underlying molecular and cytogenetic abnormalities that characterize haematologic neoplasias. It should also be noted that both scientists and clinicians make a great effort so that results from basic research are being translated into every day clinical practice for the patients’ benefit. Nowadays, we are pleased to be able to offer treatments with curative intent to a significant number of hematologic patients.
An example of successful targeted therapy, is Chronic Myeloid Leukemia (CML), where complete control of the disease can be achieve (achieved) for (in) more than 90% of treated patients. CML is characterized by the chromosomal translocation t(9;22) that creates the fusion oncogene BCR-ABL, which encodes the constitutively activated fusion protein Bcr-abl with tyrosine kinase activity. The remarkably effective treatment of CML relies on the development of specific microparticle (small molecule) inhibitors of function of the Bcr-abl fusion protein. It should be noted that until recently the only available treatment for CML patients was allogeneic transplantation, which was accompanied though with a 10-40% treatment-related mortality. The use of the first bcr/abl targeted inhibitor, imatinib, was a therapeutic revolution, while second generation inhibitors dasatinib and nilotinib, are even more potent and are thought to achieve deeper and fastest control of the disease is achieved sooner. This success in the treatment of CML with the aforementioned (μία λέξη) targeted therapy has opened new horizons in the treatment of other malignancies cancers.
Significant progress has also been made in the treatment and prognosis of Lymphomas. Chemotherapy with or without radiation in patients with early stage Hodgkin’s Lymphoma leads to a 10-year survival of over 90%, in patients with advanced stage to a 5-year survival of over 80% while in patients with Diffuse Large B-Cell Lymphoma 5-year survival exceeds 60%.
The use of pharmaceutical agents, such as bortezomib, lenalidomide and thalidomide has increased significantly the median survival of multiple myeloma patients. Except for the increase of overall survival, improvement has also been achieved in the patients’ quality of life due to the progress made in supportive care.
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