Advances in Hematology

Hematology

New technology has changed the landscape of hematology. Every day, research becomes more precise, and treatment is more accurate and personalized. The presence and value of technologies like flow cytometry and in vitro diagnostics (IVD) remain unprecedented, but what does the future have in store for hematologists – physicians and researchers alike?

When it comes to laboratory diagnosis of leukemia, for example, technology must be able to classify the type of cancer rapidly, as well as detect any residual disease during and after treatment. In this regard, flow cytometry has been the gold standard for years.

Stem Cells

In a recent interview on everything from regenerative medicine to genetic sequencing, Robert Hromas, MD, chair of Medicine at Shands Academic Health Center at the University of Florida, noted induced pluripotent stem cells (IPS) – “the subject of this year’s Nobel Peace Prize,” despite remaining in the early stages of ðdevelopment – as one of the most influential technologies in hematology.

“What they found was that they can take skin cells or cheek cells from anybody, put in four genes and turn those cheek cells or skin cells into pluripotent stem cells,” he said, discussing the ðpossibilities of IPS ðtechnology. “And, from these pluripotent stem cells, they can make platelets; they can make more skin; they can make bone; they can make neural cells – they can turn those pluripotent stem cells into many different cell types. And that’s been a huge advance in stem cell biology.”

Matured adult cells that are turned into stem cells eliminates the need to use embryonic stem cells, thus eliminating the ethical debate of harvesting fertilized embryos for stem cells, noted Hromas. While the prospect of manipulating our own cells to treat ailments is promising for hematologists, and opens doors to possibilities like the ability to manufacture different tissue types, the reality of the situation hasn’t quite caught up to the possibilities of the new approach.

“The problem is we’re not there yet,” continued Hromas. “It’s still [in the] early stage, and probably the most promising aspect of this would be making hard-to-find blood products like platelets.”

Next-Gen Sequencing

Regenerative medicine might be catching up, but other up-and-coming technologies like next-generation sequencing (NGS) are here and making strides in modern medicine. As scientists are able to process and interpret information provided by genetic code more quickly, treatment for diseases could become tailored to an individual’s DNA for the most effective results. Hromas, a specialist in blood cancers, already uses NGS in a diagnostic capacity, but the potential applications range far beyond diagnosis.

“In your lifetime, you will have your DNA sequenced,” he explained. “And we will know what risks you will have of blood pressure being high, of heart attacks, of strokes, of cancer, and you can change your lifestyle. We can prevent those things from happening with the right interventions with lifestyle – no one likes to hear that – and also perhaps medication.”

Although the medical uses of NGS in regards to treatment have been documented in drugs that work at the molecular level, like Imatinib and Ponatinib for Chronic Myeloid Leukemia (CML), there is still much work left to be done in genetic drug development for genetic targets. Another area that stands to make big difference is NGS in a preventative capacity – the concept of knowing what diseases an individual might be predisposed to become affected by over time. This knowledge could influence better work, dietary and stress habits for vulnerable individuals.

“So, next-generation sequencing will lead to personalized medicine not just in treating cancers,” Hromas continued, “but in what cancers you might be susceptible to develop in the future.”

Nanotechnology

Hromas also discussed both nanotechnology and immune therapy of blood cancers as potential big developments. Most, but not all, patients with non-Hodgkin’s lymphoma, for example, can be cured thanks to effective medicines. The addition of nanotechnology and imaging could become important breakthroughs in research on non-Hodgkin’s lymphoma, allowing hematologists to track the disease.

“Can we define lymphoma that’s been hiding out in the liver after treatment? Can we find that with labeling nanoparticles that would hone to the lymphoma?” Said Hromas, “We could use an x-ray to see that. The use of nanotechnology and imaging is a future strategic plan.”

Drug Development

In the progress of hematology drugs, the concept of synthetic lethality is promising. Essentially, as cells form mutations in their DNA, they begin to divide without stopping, causing them to become cancerous. To make up for the defect in the original pathway, the cells try to repair themselves – again, dividing until they become cancerous. By attacking and inhibiting the backup pathways of DNA repair, the cancer cells are unable to divide.

“Some very bright people a few years ago decided, ‘hey, if we attack those backup pathways of DNA repair that [the cancerous cells are] addicted to, and these backup pathways are required for the cancer cell to divide, by knocking off those backup pathways, the cancer cells can’t divide.’ That’s synthetic lethality,” explained Hromas, calling it “the most important development in drug discovery in the last 15 years.”

Michael Jones is on staff at ADVANCE.