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Malignant hematopoietic neoplasm — Clinical Guidelines

Overview

Malignant hematopoietic neoplasms encompass a variety of cancers affecting blood-forming tissues, including leukemias, lymphomas, and myeloma, characterized by uncontrolled proliferation of hematopoietic cells.

Diagnosis

Morphological examination: Essential for identifying abnormal cell populations 37.

Immunophenotyping: Utilizes flow cytometry to characterize cell surface markers 37.

Molecular biology techniques: Including cytogenetics and next-generation sequencing for genetic abnormalities 33 38.

Biomarker analysis: Utilizes biological markers for risk stratification and diagnosis 33.

Management

Chemotherapy: Primary treatment modality, tailored based on specific malignancy and genetic profile 35 38.

Targeted therapy: Utilizes drugs targeting specific molecular pathways (e.g., tyrosine kinase inhibitors) 35.

Red blood cell transfusions: Consider restrictive versus liberal strategies based on clinical context and patient tolerance 3.

Antifungal prophylaxis: Recommended for high-risk patients undergoing intensive chemotherapy or stem cell transplantation 8 18.

Palliative care integration: Essential for symptom management and quality of life improvement throughout the disease course 6 19 20.

Special Populations

Pediatrics: Requires specialized nursing mentorship programs to support novice nurses 2.

Elderly: Geriatric hematology programs are crucial for managing comorbidities and improving outcomes 15.

Comorbidities: Consideration of nutritional support, especially in CAR T cell therapy patients, to maintain nutritional status 13.

Key Recommendations

Implement restrictive red blood cell transfusion strategies when clinically appropriate to manage anemia in patients with hematological malignancies (Evidence: Moderate) 3.

Integrate palliative care early in the disease trajectory to enhance quality of life and symptom management (Evidence: Strong) 6 19 20.

Provide antifungal prophylaxis for patients undergoing intensive chemotherapy or stem cell transplantation to reduce invasive fungal disease risk (Evidence: Strong) 8 18.

Offer specialized support and mentorship programs for healthcare providers, particularly in pediatric hematology-oncology settings, to mitigate burnout and improve care quality (Evidence: Expert opinion) 17.

Tailor treatment approaches, including targeted therapies, based on genetic and molecular profiling to optimize outcomes (Evidence: Strong) 35 38.

References

1 Khurram S, Qureshi MA. Haematological Malignancies in Pakistan: A Critical Gap in Cancer Registration Requiring Urgent Attention. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 2025. link 2 Gandhi S, Petropoulos A, Pires LA. Development of a Nursing Mentorship Program in a Haematology/Oncology/Blood and Marrow Transplant and Cellular Therapy at a Tertiary Paediatric Hospital. Journal of pediatric hematology/oncology nursing 2025. link 3 Radford M, Estcourt LJ, Sirotich E, Pitre T, Britto J, Watson M et al.. Restrictive versus liberal red blood cell transfusion strategies for people with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without haematopoietic stem cell support. The Cochrane database of systematic reviews 2024. link 4 Liberati C, Barbieri E, Cavagnero F, Petris MG, Brigadoi G, Reggiani G et al.. Impact of a two step antimicrobial stewardship program in a paediatric haematology and oncology unit. Scientific reports 2024. link 5 Butt A, Christian J, Kress A, Lu BY, Hurwitz ME, Goldberg SB et al.. Providing 0.1 Full-Time Equivalent (FTE) Support to Fellowship Core Faculty Improves Faculty Involvement in Fellowship Education and Recruitment. Journal of cancer education : the official journal of the American Association for Cancer Education 2024. link 6 Di Lorenzo S, Mozzi L, Salmaso F, Silvagni C, Soffientini S, Valenti V et al.. A multicentre survey on the perception of palliative care among health professionals working in haematology. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2024. link 7 Kim A, O'Callaghan A, Hemmaway C, Johney L, Ho J. Quality outcomes for end-of-life care among people with haematological malignancies at a New Zealand cancer centre. Internal medicine journal 2024. link 8 Stemler J, Mellinghoff SC, Khodamoradi Y, Sprute R, Classen AY, Zapke SE et al.. Primary prophylaxis of invasive fungal diseases in patients with haematological malignancies: 2022 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO). The Journal of antimicrobial chemotherapy 2023. link 9 Maha O, Nawal O, Youssef A, Samir B, Hajar M, Noufissa A et al.. Hypovitaminosis D in Haematological Malignancies: Cause or Consequence?. Nutrition and cancer 2023. link 10 Kuhlman PD, Williams D, Russell G, Amornmarn A, Harbaugh J, Woods R et al.. Just-in-Time Teaching (JiTT) Screencasts: a Randomized Controlled Trial of Asynchronous Learning on an Inpatient Hematology-Oncology Teaching Service. Journal of cancer education : the official journal of the American Association for Cancer Education 2022. link 11 Wästerlid T, Cavelier L, Haferlach C, Konopleva M, Fröhling S, Östling P et al.. Application of precision medicine in clinical routine in haematology-Challenges and opportunities. Journal of internal medicine 2022. link 12 Marshall AL, Halfdanarson TR, Alkhateeb H, Hobday T. Pilot Study Characterizing the Hematology-Oncology Fellow Job Search Process: Tools Used and Identification of Potential New Resources. Journal of cancer education : the official journal of the American Association for Cancer Education 2022. link 13 Cucchiaro B, Weekes CE. Systematic review of nutrition support interventions in adult haematology and oncology patients receiving CAR T cell therapy. Clinical nutrition ESPEN 2021. link 14 Visacri MB, Tavares MG, Barbosa CR, Duarte NC, Moriel P. Clinical pharmacy in onco-hematology and bone marrow transplant: A valuable contribution to improving patient safety. Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners 2021. link 15 Soto-Perez-de-Celis E, Martínez-Peromingo J, Chávarri-Guerra Y, Loh KP, Demichelis-Gómez R, Rodrigues M et al.. Implementation of geriatric haematology programmes for the treatment of older people with haematological malignancies in low-resource settings. The lancet. Healthy longevity 2021. link00182-3) 16 Warsame RM, Asiedu GB, Kumbamu A, Cook J, Hayes SN, Thompson CA et al.. Assessment of Discrimination, Bias, and Inclusion in a United States Hematology and Oncology Fellowship Program. JAMA network open 2021. link 17 Blazin LJ, Terao MA, Spraker-Perlman H, Baker JN, McLaughlin Crabtree V, Mandrell BN et al.. Never Enough Time: Mixed Methods Study Identifies Drivers of Temporal Demand That Contribute to Burnout Among Physicians Who Care for Pediatric Hematology-Oncology Patients. JCO oncology practice 2021. link 18 Christopeit M, Schmidt-Hieber M, Sprute R, Buchheidt D, Hentrich M, Karthaus M et al.. Prophylaxis, diagnosis and therapy of infections in patients undergoing high-dose chemotherapy and autologous haematopoietic stem cell transplantation. 2020 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Annals of hematology 2021. link 19 Wedding U. Palliative care of patients with haematological malignancies: strategies to overcome difficulties via integrated care. The lancet. Healthy longevity 2021. link00213-0) 20 Odejide OO, Steensma DP. Patients with haematological malignancies should not have to choose between transfusions and hospice care. The Lancet. Haematology 2020. link30042-9) 21 Ben Salah N, Salouage I, Hatira ZZ, Goucha R, Meherzi A, Kallel K. Multidisciplinary exams in medical studies : Interest of docimologic analysis. La Tunisie medicale 2019. link 22 De Sanctis V. Haematological malignancies in Qatar: from childhood to adulthood. Acta bio-medica : Atenei Parmensis 2018. link 23 von Lilienfeld-Toal M, Maschmeyer G. Challenges in Infectious Diseases for Haematologists. Oncology research and treatment 2018. link 24 Ruhnke M, Behre G, Buchheidt D, Christopeit M, Hamprecht A, Heinz W et al.. Diagnosis of invasive fungal diseases in haematology and oncology: 2018 update of the recommendations of the infectious diseases working party of the German society for hematology and medical oncology (AGIHO). Mycoses 2018. link 25 Mellinghoff SC, Panse J, Alakel N, Behre G, Buchheidt D, Christopeit M et al.. Primary prophylaxis of invasive fungal infections in patients with haematological malignancies: 2017 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO). Annals of hematology 2018. link 26 Gerçeker GÖ, Sevgili SA, Yardımcı F. Impact of flushing with aseptic non-touch technique using pre-filled flush or manually prepared syringes on central venous catheter occlusion and bloodstream infections in pediatric hemato-oncology patients: A randomized controlled study. European journal of oncology nursing : the official journal of European Oncology Nursing Society 2018. link 27 Moreno-Alonso D, Porta-Sales J, Monforte-Royo C, Trelis-Navarro J, Sureda-Balarí A, Fernández De Sevilla-Ribosa A. Palliative care in patients with haematological neoplasms: An integrative systematic review. Palliative medicine 2018. link 28 Langerak AW, Brüggemann M, Davi F, Darzentas N, van Dongen JJM, Gonzalez D et al.. High-Throughput Immunogenetics for Clinical and Research Applications in Immunohematology: Potential and Challenges. Journal of immunology (Baltimore, Md. : 1950) 2017. link 29 Dignan FL, Clark A, Aitken C, Gilleece M, Jayakar V, Krishnamurthy P et al.. BCSH/BSBMT/UK clinical virology network guideline: diagnosis and management of common respiratory viral infections in patients undergoing treatment for haematological malignancies or stem cell transplantation. British journal of haematology 2016. link 30 Eid A, Hsieh P, Shah P, Wolff R. Cross-sectional longitudinal study of the academic half-day format in a hematology-oncology fellowship training program. BMC medical education 2015. link 31 LeBlanc TW, Smith JM, Currow DC. Symptom burden of haematological malignancies as death approaches in a community palliative care service: a retrospective cohort study of a consecutive case series. The Lancet. Haematology 2015. link00111-8) 32 Brodská H, Malíčková K, Štastná MM, Zima T. Pitfalls in the laboratory assessment of serum prealbumin levels in hemato-oncological patients. Clinical laboratory 2014. link 33 Lemal R, Tournilhac O, Bay JO. Biological markers in haematological malignancies. Bulletin du cancer 2014. link 34 Ozkocaman V, Ozcelik T, Ali R, Ozkalemkas F, Ozkan A, Ozakin C et al.. Bacillus spp. among hospitalized patients with haematological malignancies: clinical features, epidemics and outcomes. The Journal of hospital infection 2006. link 35 Haas M, Lonial S. Targeted therapy for haematological malignancies: clinical update from the American Society of Hematology, 2004. Expert opinion on investigational drugs 2005. link 36 McGrath P. Are we making progress? Not in haematology!. Omega 2002. link 37 Jack AS, Morgan GJ. The development of haematopathology laboratories: a possible model for other pathology services. The Journal of pathology 1998. link1096-9896(199803)184:3<231::AID-PATH21>3.0.CO;2-6) 38 Campbell K. Future treatment options for haematological malignancies. Nursing times 1996. link

Malignant hematopoietic neoplasm