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Treating patients with oncohaematological diagnoses is still a challenge for even the best doctors in the world. However, in recent years there has been significant progress in the fight against leukaemia, lymphoma, myeloma, anaemia and other serious diseases. Overall success rates are improving, while side effects are decreasing, and the therapy itself is becoming gentler on the patient. Let’s take a look at what modern oncohaematology has achieved…..

 

 

Bone marrow transplantation (BMT)

It is difficult to give a specific figure when it comes to the success rate of bone marrow transplantation. This is because there are different types of transplantation: autologous, allogeneic, haploidentical, and unrelated. However, for example, the success rate of BMT in the best Turkish clinics is up to 90%. And the statistics of bone marrow rejection in those hospitals are practically zero.

 

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Now the main cause of death in bone marrow transplantation is infections. But soon this problem will be solved. Today, the leading BMT centres create a special environment in which the patient is almost completely protected from infections.

 

For example, in the network of Turkish clinics Liv Hospital, which is considered to be one of the leaders in this area, has special rooms where patients’ guests are cleansed from infections.

 

However, sterile wards and rooms alone are unfortunately not enough. In this matter, the qualification of specialists who can recognise the presence of infection in the patient in time is very important.

 

On top of all this is the need to have a full range of antibiotics, as well as free access to diagnostic equipment, to promptly confirm or deny the diagnosis.


In recent years, the best medical centres in the world have taken all these points into account and thoughtfully considered them, contributing to a significant breakthrough in the fight against oncohaematological diseases.


Bone marrow transplantation is a specialised therapy for patients with certain types of cancer or other diseases. The procedure involves taking bone marrow cells from a patient or donor, filtering these cells, and returning them to the patient’s body. The goal of BMT is to cure many diseases and some cancers. When the doses of chemotherapy or radiation required for cancer therapy are so high that a person’s bone marrow stem cells are permanently damaged by the treatment, a bone marrow transplant may be necessary. It may also be necessary if the bone marrow is destroyed by disease.

 

Matching the donor and recipient involves tissue typing for human leukocyte antigen (HLA). Antigens on the surface of these special white blood cells determine the genetic makeup of the human immune system. There are at least 100 HLA antigens. However, it is believed that there are a few major antigens that determine whether a donor and recipient are a match.

 

Most of the genes that “code” for the human immune system are on a single chromosome. Since we only have two of each chromosome, one from each parent, a sibling of a patient in need of a transplant has a 1 in 4 chance of having the same set of chromosomes and having a “maximum match” for the transplant.

 

A bone marrow transplant can be used to:

    иконка галочки Replacing non-functioning bone marrow with healthy marrow (for conditions such as leukaemia, aplastic anaemia and sickle cell anaemia).

    иконка галочки Replacing bone marrow and restoring its normal function after the administration of high doses of chemotherapy and/or radiation to treat malignancies. This process is often referred to as stem cell rescue.

    иконка галочки Restoring the immune system to fight existing or residual leukaemia or other cancers not destroyed by chemotherapy or radiation.

    иконка галочки Bone marrow replacement with genetically healthy functioning bone marrow to prevent damage from developing a genetic disease (Hurler syndrome and adrenoleukodystrophy).

Immunotherapy and monoclonal antibodies

In the late 2000s, the world learnt about monoclonal antibodies as a breakthrough in cancer treatment. At that time, they were only used for a few cancers, but today monoclonal antibody therapy is available for almost all types of cancer.


This also applies to oncohaematology: monoclonal antibodies treat all non-Hodgkin’s and Hodgkin’s lymphomas. They are artificially created variants of immune system proteins. Monoclonal antibodies produce clone cells derived from a single progenitor cell. They fall into two groups: monoclonal antibodies that simply tag cancer cells for immunity, and those that deliver a drug to the cancer cells.


The first kind is most often used, such as Alemtuzumab for lympholeukaemia therapy, Rituximab for B-cell lymphoma therapy, and others.

 

The second type of monoclonal antibodies are those that transfer chemopreparations or radioactive particles to cancer cells. These include, for example, Ibritumomab (Zevalin) for the treatment of non-Hodgkin’s lymphoma.

 

Monoclonal antibodies have been a real breakthrough in oncohaematology – firstly, because they do not attack the whole body, unlike chemotherapy.

 

Secondly, they have far fewer side effects than other treatments, particularly chemotherapy or radiotherapy. Finally, these drugs are now available even in pill form, making the treatment process much easier for the patient.

 

Over the past few years, medicine has made a huge step forward in the treatment of oncohaematological diseases. This is confirmed from personal experience by the best specialists in the world. However, no matter how fast the world moves in the invention of innovative therapies, the truth remains the same – the success of treatment still depends on the quality and timeliness of diagnosis. The most difficult thing is to help a patient who has already been treated for a non-existent disease.

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CAR-T cell therapy

Until recently, the use of CAR-T-cell therapies was limited to clinical trials, mainly in patients with advanced blood cancers. However, these therapies have nevertheless attracted the attention of researchers and the general public. The results that have been achieved in some patients have exceeded possible expectations. Clinical trials conducted by Aristotle University in Greece showed that more than 92% of patients with stage 4 acute lymphocytic leukaemia were completely free of the disease. There have also been positive results in the treatment of metastasising lymphoma.

 

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In 2017, the Food and Drug Administration (FDA) approved two CAR T-cell therapies: one for the treatment of children with acute lymphoblastic leukaemia (ALL), and one for adults with advanced lymphoma.

 

CAR-T therapy is a cell therapy, gene therapy and immunotherapy all at the same time. Carrying out the procedure involves taking blood from patients and separating T-cells. This process is called leukapheresis. The T-cells are then genetically modified to express the CAR molecule and multiply.

 

Finally, they are injected back into the patient. The T-cells, which carry a chimeric antigen receptor (CAR) on the cell membrane, recognise certain molecules in the tumour cell and destroy the nidus.

 

Immunotherapy based on checkpoint inhibitors has been quite successful in certain groups of cancer patients.

 

Checkpoint inhibitors block the mechanism that tumour cells use to hide from immune cells. CAR-T cell-based immunotherapy goes one step further by engineering the T-cells themselves to boost the natural immune response against a specific tumour antigen.

 

    Researchers from the University of Pennsylvania recently reported in the journal Nature that the first two people treated with CAR-T cells had remission even after 12 years.

 

 

    Summary

    иконка галочки In recent years, the best medical centres in the world have taken all these points into account and thought out, contributing to significant breakthroughs in the fight against oncohaematological diseases. Bone marrow transplantation is among them. There are different types of transplantation: autologous, allogeneic, haploidentical, and unrelated. In leading BMT centres, the rate of donor organ rejection is practically zero.

    иконка галочки In the late 2000s, there was a real breakthrough in cancer treatment – the world learnt about monoclonal antibodies. At that time they started to be used for only a few cancers, but today monoclonal antibody therapy is available for almost all types of cancer.

    иконка галочки CAR therapy is simultaneously cell therapy, gene therapy and immunotherapy. Carrying out the procedure involves taking blood from patients and separating T-cells. This process is called leukapheresis. The T-cells are then genetically modified to express the CAR molecule and multiply. Finally, they are injected back into the patient. T-cells that carry the chimeric antigen receptor (CAR) on the cell membrane recognise certain molecules in the tumour cell and destroy the tumour.

 

Learn more about the latest advances in oncohaematology from the MediGlobus platform coordinating physicians. Our experts will answer all your questions and help you solve your medical problem. Contact us!

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Sources:

  1. 1. Nature
  2. 2. American Society of Clinical Oncologists
  3. 3. American Cancer Society
  4. 4. World Health Organization
  5. 5. National Cancer Institute
  6. 6. Current Pharamaceutical Biotechnology


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