Comment: 'Doctor, do I have cancer?'
John Reilly
pp 2-2
The recently updated WHO diagnostic criteria for essential thrombocythaemia (ET) have reduced the threshold platelet count to 450 x 109/l, thereby ensuring that clinicians will diagnose and treat more patients, especially those over the age of 60. Inevitably, haematologists will spend an increasing amount of time explaining the nature of the disease and the rationale for therapy. But how should we respond to the deceptively simple question: ‘Does this mean I have cancer, doctor?’
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Acute myeloid leukaemia in older patients: the challenges
Morag Griffin and Christopher Dalley
pp 3-6
Acute myeloid leukaemia (AML) is a malignant disease of the haemopoietic tissues characterised by the abnormal proliferation of myeloid leukaemic blasts and impaired production of normal blood cells. It accounts for 80% of all adult leukaemias, and approximately 7% of all haematological malignancies. In the West, the incidence of AML increases with age – two per 100,000 in patients under the age of 60 years, peaking at 15–20 per 100,000 in adults over the age of 75 years.
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Diagnosis and prognosis of myelodysplastic syndromes: part two
Lynn Quek and Paresh Vyas
pp 7-9
Issue 5.2 of MDIP looked at the history and classification of myelodysplastic syndromes (MDS), and began to examine diagnosis through determining clonal abnormalities. In the second part of this two-part article, testing to determine mutations and the use of novel therapies add to the review of detecting MDS. A number of point mutations have been identified in MDS patients over several decades. Initial studies focused on known oncogenes and tumour suppressor genes, but the later arrival of whole genome single nucleotide polymorphism (SNP) array technology enabled the discovery of a whole cache of novel MDS-associated mutations.
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New therapies in acute myeloid leukaemia
Frances Wadeline and Nigel Russell
pp 10-13
Acute myeloid leukaemia (AML) is a heterogeneous neoplastic disorder precipitated by the accumulation of somatically acquired genetic alterations that disrupt the self-renewal, proliferation and differentiation of normal haematopoiesis, leading to the clonal proliferation of myeloid progenitor cells. It is the most common acute leukaemia in adults, with an incidence of 3.7 per 100,000 people, and often presents with symptoms of bone marrow failure. Recent national trials have reported complete remission rates of 84%, with five-year overall survival (OS) rates of 42% in younger patients able to tolerate intensive chemotherapy (data from MRC AML15).
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The 'expert patient' with a haematological malignancy
Eric Low
pp 14-15
A decade has passed since the Chief Medical Officer (CMO) of the time introduced the concept of the ‘expert patient’. The rationale behind the need for expert patients was that in the new millennium, many people were living into their seventh, eighth and often ninth decades. As a consequence, the burden of common long-term conditions such as heart disease, the results of stroke, cancer, arthritis and diabetes, to name a few, became much more apparent, and the era of long-term, chronic condition management was born.
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