Overview
Malignant myeloid/lymphoid neoplasms encompass a heterogeneous group of hematologic malignancies characterized by uncontrolled proliferation of myeloid or lymphoid cells, often requiring multidisciplinary management including supportive care and specialized training for optimal outcomes. 346Diagnosis
Comprehensive blood counts with peripheral smear examination to identify abnormal cell morphology.
Bone marrow biopsy and aspirate for definitive diagnosis and cytogenetic analysis.
Flow cytometry and immunohistochemistry to characterize cell lineage and markers.
Molecular testing for specific genetic mutations (e.g., FLT3, NPM1 in AML).
Imaging studies (CT, MRI) to assess extent of disease and organ involvement. 34Management
First-line treatments:
- Acute myeloid leukemia (AML): Induction chemotherapy with cytarabine and an anthracycline (e.g., daunorubicin).
- Chronic myeloid leukemia (CML): Tyrosine kinase inhibitors such as imatinib, dasatinib, or nilotinib.
Adjunctive therapies:
- Supportive care including transfusions, antibiotics, and management of cytopenias.
- Allogeneic hematopoietic stem cell transplantation for high-risk or refractory cases.
Supportive care services: Integration with anesthesiology for managing painful procedures, aiming for timely consultations and efficient procedural workflows. 36Special Populations
Pediatrics: Specific considerations for pediatric myeloid/lymphoid neoplasms include tailored chemotherapy regimens and supportive care tailored to developmental stages, though specific details are not covered in the abstracts.
Elderly: Management often involves risk stratification to balance efficacy and toxicity, potentially favoring less intensive regimens. 4
Comorbidities: Comprehensive assessment and management of comorbidities are crucial, impacting treatment selection and supportive care strategies. 6Key Recommendations
Facilitate diverse mentorship and career guidance early in fellowship training to prepare fellows for varied career paths in hematology/oncology. (Evidence: Expert opinion) 1
Integrate supportive care services closely with hemato-oncology units to ensure timely and efficient management of painful procedures and patient care. (Evidence: Moderate) 3
Incorporate systems-based competency training through innovative methods like editorial clubs to enhance fellows' understanding of broader healthcare systems impacting patient care. (Evidence: Moderate) 5
Promote completion of clinical projects and secure mentorship for fellows aiming for academic careers in patient-oriented clinical research. (Evidence: Moderate) 6References
1 LaCasce A, Graff S, Gao J, Close J, Boulmay B. Preparing Fellows for Graduation: Perspectives on Career Guidance. American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting 2019. link
2 Graff SL, Close J, Cole S, Matt-Amaral L, Beg R, Markham MJ. Impact of Closed Facebook Group Participation on Female Hematology/Oncology Physicians. Journal of oncology practice 2018. link
3 Mercadante S, Costanzi A, David F, Villari P, Musso M, Marchetti P et al.. Supportive care services in hemato-oncology centers: a national survey. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2016. link
4 Kyei M, Lavelle E, Kyasa J, Safar M, Makhoul I, Mehta P. Triaging referrals as part of hematology/oncology fellowship training. Journal of cancer education : the official journal of the American Association for Cancer Education 2010. link
5 Safar AM, O'Sullivan P, Ray L, Hutchins L, Mehta P. Editorial clubs as a new teaching tool in postgraduate training. Journal of cancer education : the official journal of the American Association for Cancer Education 2006. link
6 Gitlin SD, Yuan Z, Little RJ, Todd Iii RF. Factors that influence successful training and faculty career development in hematology/oncology patient-oriented clinical research. Journal of cancer education : the official journal of the American Association for Cancer Education 2005. link