Chapter 179. Hematologic Malignancies

1. What are the “classic” clinical and basic laboratory features of each of the common hematologic malignancies? (“How do I prove the diagnosis?”)

2. What is the natural history of each disease entity without therapy?

3. What is the goal of treatment for each disease entity (cure, prolongation of survival, or purely palliation)?

4. Which modalities may be employed for each disease entity (chemotherapy, immunotherapy, radiation, stem cell transplant)?

5. What is the prognosis with therapy? How can the prognosis estimate be refined?

6. What needs to be done to prepare the patient for therapy (to communicate risks and benefits and to reduce toxicity)?

7. How do we assess the response?

8. How do we monitor the patient after completion of therapy, both early on (for relapse) and later (for delayed toxicities of therapy)?

Introduction

Practitioners need to be familiar with the broad classes of hematologic malignancy (acute and chronic leukemias, aggressive and indolent lymphomas, myeloma, myeloproliferative neoplasms, and myelodysplastic syndromes). They should also be familiar with the side effects of therapy, for example, acute and chronic cardiotoxicity from anthracyclines, long-lasting immunosuppression from purine analogs, and the expected timing of neutropenia (Table 179-1). He or she should also be comfortable managing a number of hematologic emergencies, which are described in the following chapter. The specifics of diagnosis and treatment can be both subtle and complex. Subspecialty consultation with a hematologist or oncologist is essential in caring for a patient who is suspected or known to suffer these conditions.