What is hematology oncology?

What is Haemato-Oncology & BMT?

• Haemato-Oncology (or Hematologic Oncology) is the branch of medicine that deals with the diagnosis, treatment, and management of cancers of the blood, bone marrow, and lymphatic system. These are collectively known as haematological malignancies.
• Bone Marrow Transplantation (BMT), now more commonly called Haematopoietic Stem Cell Transplantation (HSCT), is a specialized medical procedure often used to treat certain haematological cancers and other diseases. It involves replacing a patient’s diseased or damaged bone marrow with healthy stem cells.

These two fields are intrinsically linked, as BMT is a cornerstone treatment for many high-risk or relapsed blood cancers.

2. Types of Haematological Malignancies

They are broadly categorized into three main types:

1. Leukaemias

Cancers that originate in the blood-forming tissues of the bone marrow, leading to overproduction of abnormal white blood cells.

• Acute Lymphoblastic Leukaemia (ALL): Common in children, but also occurs in adults.
• Acute Myeloid Leukaemia (AML): Occurs in both adults and children.
• Chronic Lymphocytic Leukaemia (CLL): Most common in older adults.
• Chronic Myeloid Leukaemia (CML): Characterized by the Philadelphia chromosome.

1. Lymphomas

Cancers that develop in the lymphatic system (lymph nodes, spleen, thymus). The two main categories are:

• Hodgkin Lymphoma (HL): Characterized by the presence of Reed-Sternberg cells. Generally has a high cure rate.
• Non-Hodgkin Lymphoma (NHL): A very large and diverse group of lymphomas (e.g., Diffuse Large B-Cell Lymphoma, Follicular Lymphoma).

1. Myelomas

Cancer of the plasma cells, a type of white blood cell in the bone marrow that produces antibodies.

• Multiple Myeloma (MM): The most common type, affecting multiple areas of the body.

1. Other Myeloproliferative Neoplasms (MPNs) and Myelodysplastic Syndromes (MDS)

• MDS: A group of disorders where the bone marrow does not produce enough healthy blood cells, often considered a precursor to AML.
• MPNs: Conditions where the bone marrow produces too many of one type of blood cell (e.g., Polycythemia Vera, Myelofibrosis).

3. Bone Marrow Transplantation (BMT) / Stem Cell Transplantation (SCT)

This is a potentially curative treatment for many blood cancers.

Types of Transplants:

• Autologous Transplant (“Auto”)
  • Source: The patient’s own stem cells are collected, frozen, and stored.
  • Process: The patient receives high-dose chemotherapy (and sometimes radiation) to destroy the cancer. The stored stem cells are then infused back into the patient to “rescue” the bone marrow.
  • Commonly used for: Multiple Myeloma, Hodgkin’s and some Non-Hodgkin Lymphomas.
• Allogeneic Transplant (“Allo”)
  • Source: Stem cells come from a donor. This can be a matched sibling (sibling allogeneic), a matched unrelated donor (MUD), a haploidentical (half-matched) family member (e.g., parent or child), or cord blood.
  • Process: The patient receives conditioning therapy (chemotherapy/radiation). The donor’s stem cells are infused. The new immune system from the donor can help fight any remaining cancer cells (a “graft-versus-tumour” effect).
  • Commonly used for: Acute Leukaemias (AML, ALL), MDS, Myeloproliferative Neoplasms, and some lymphomas.
  • Major Complication: Graft-versus-Host Disease (GvHD), where the donor’s immune cells attack the patient’s body.

4. The Treatment Journey (Simplified)

1. Diagnosis: Precise diagnosis through blood tests, bone marrow biopsy, imaging (CT/PET scans), and advanced genetic/molecular profiling.
2. Risk Stratification: Determining the aggressiveness of the disease and the best treatment approach based on genetic markers.
3. Induction Therapy: Initial treatment (usually chemotherapy, often combined with immunotherapy or targeted therapy) to achieve remission.
4. Consolidation/Therapeutic Plan: Further treatment to eliminate any remaining cancer cells. This could be more chemotherapy, radiation, or a BMT.
5. Transplant Process (if applicable):
   • Conditioning: High-dose therapy to wipe out the bone marrow.
   • Stem Cell Infusion: The transplant itself is like a blood transfusion.
   • Engraftment: The 2-4 week period where the new stem cells start to grow and produce blood cells. This is a critical time with high risk for infections and complications.
   • Recovery & Monitoring: Long-term follow-up to manage side effects, prevent infections, and watch for relapse or GvHD.

5. Recent Advances & Innovations

The field is evolving rapidly, improving outcomes and reducing toxicity.

• CAR T-Cell Therapy: A type of immunotherapy where a patient’s T-cells are genetically engineered to recognize and kill cancer cells. A revolutionary treatment for certain relapsed/refractory B-cell lymphomas and leukaemias.
• Targeted Therapies: Drugs that specifically target molecular pathways or mutations in cancer cells (e.g., tyrosine kinase inhibitors for CML, BTK inhibitors for CLL).
• Reduced-Intensity Conditioning (RIC) Allo Transplants: Allows older and less fit patients to receive a transplant by using less toxic chemotherapy.
• Better Supportive Care: Improved anti-fungal, anti-viral, and anti-bacterial drugs, as well as better management of GvHD and nausea.
• Haploidentical Transplants: Expanding the donor pool so almost every patient who needs a transplant can find a donor (often a half-matched family member).

6. The Multidisciplinary Team

Treating these diseases requires a team of specialists:

• Haemato-Oncologists
• BMT Physicians
• Transplant Coordinators
• Specialized Nurses
• Pharmacists
• Dietitians
• Physical Therapists
• Psychosocial Support (Social Workers, Psychologists)

In summary, Haemato-Oncology and BMT represent a dynamic and highly specialized field focused on curing complex blood cancers through a combination of chemotherapy, innovative immunotherapies, targeted drugs, and the powerful tool of stem cell transplantation. The future is focused on making treatments more effective, less toxic, and more personalized.