Hematology is on a path of progress, as the integration of innovation has led to the identification of many and complex molecular changes, and through them, to “precision hematology”.
This was emphasized by the president of the Hellenic Hematology Society, Elisavet Grouzi, on the occasion of the 34th Panhellenic Hematology Congress (PAS), which will be held in Athens from November 9 to 11, 2023.
In the relevant press conference, the Vice-President of the EAE, Professor Theodoros Vasilakopoulos, noted that in the last 30 years, leaps and bounds have been made in all fields of Hematology.
The application of new diagnostic methods based on advances in Technology and Biology results in more accurate diagnosis and classification of both benign and neoplastic blood diseases, as well as the application of innovative targeted therapies, which we have the ability to apply to our own our patients, in our country.
A lecture will be given by Harvard Medicine Professor Vassiliki Busiotis, who first discovered that cancer attacks the bone marrow from a very early stage, blocking the immune system
A “natural killer” cell (orange), attacks a cancer cell
The access of Greek patients to innovative (and particularly expensive) treatments is seamless and probably better than that enjoyed by citizens of highly developed countries in the Western world.
Advances in the field of treatment have already resulted in the cure of more patients and the prolongation of survival with an excellent quality of life for even more. The price of this great success, desirable for society, is the increase in the number of hematological patients and the increased needs for follow-up and hospitalization.
This means that it becomes imperative to solve chronic problems by increasing hospital beds for hematological patients, the capacity of specialized outpatient clinics and short-term hospitalization units, and further staffing the health system with medical, nursing and administrative staff.
Improving nursing care
Overall, the Hematology Society, given the progress that has been made, considers it necessary to support the work of hematologists from the State.
The interventions deemed necessary and imperative, among others, at this stage are:
- The costing and institutionalization of the compensation of the laboratory control of biomarkers
- The increase of beds in the Hematology Clinics and Units for the Transplantation of Primordial Hematopoietic Cells and Cell Therapies
- Strengthening the infrastructure and staffing of Hematology Departments, Transplantation Units, and Blood Donation Services with the necessary medical, nursing and technological personnel, and
- The improvement of the conditions of hospitalization of hematological patients.
According to Mr. Vasilakopoulos, in recent years significant progress has been made in understanding the biology of neoplasms of both lymphatic and myeloid origin, such as lymphomas, acute leukemias and myelodysplastic syndromes, with the identification of genetic disorders (also known as “biomarkers ”) that are of particular importance for the prognostic classification and treatment of these diseases.
In the era of Precision Medicine, the application of sophisticated laboratory methods for their identification, in addition to a more complete understanding of the pathogenesis of the disease and the development of molecular targeting therapies, leads to the early prediction of the imminent recurrence of many neoplastic diseases of the hematopoietic system and to the timely therapeutic intervention that improves patient outcome.
EAE Special Secretary Maria Bouzani spoke about the newest drugs, saying that they not only prolong overall survival, but also significantly improve the quality of life, especially for older patients, who are unable to receive aggressive chemotherapy. Of course, allogeneic hematopoietic cell transplantation remains the curative treatment for the majority of patients with acute leukemia. The indications of transplantation are expanding and the number of patients who are candidates and can undergo transplantation is increasing, which is why it is necessary to increase the transplantation activity by expanding the number of beds in the Transplantation Units.
The General Secretary of the EAE, Irini Katodrytou, pointed out that special emphasis will also be placed on the newest therapeutic developments in hematological malignancies, including developments in immunotherapy with new monoclonal antibodies, conjugated antibodies, bispecific antibodies, inhibitors of signaling pathways and genetically modified T lymphocytes, which carry a chimeric antigen receptor on their surface (CAR-T lymphocytes).
Therapies with these genetically modified T-lymphocytes are European Medicines Agency (EMA) approved therapies for the treatment of an ever-increasing number of hematological malignancies that are resistant to conventional therapy. The diseases for which the above treatment is indicated are acute lymphoblastic leukemia in children and adults, large B-cell lymphomas, mantle cell lymphoma, lymphoid lymphomas and multiple myeloma.
For her part, Mrs. Bouzani emphasized that the administration of these treatments is carried out under close monitoring and specific conditions, which are met only by the primordial hematopoietic cell transplantation units, with parallel coverage by an Intensive Care Unit, to deal with immediate complications from the treatment that may occur in these patients. In Greece, several patients have already been treated with CAR-T lymphocytes. With the expansion of indications, patients in need of these treatments will be more in the near future.
Regarding clinical studies, Mrs. Katodrytou emphasized that the Hellenic Society of Hematology has contributed significantly to the development of clinical studies in various hematological diseases, assuming the role of the scientific body for the management of a large number, spearheaded by multiple myeloma.
In this way, it contributes decisively to scientific progress, the development of innovative treatments and the training of younger doctors. Results of such tests will be presented at the conference.
For his part, Mr. Vasilakopoulos praised the EAE’s contribution to international clinical protocols and to collaborative groups with an international reach that have been developed by the members of the EAE’s Scientific Departments, such as the Department of Myelodysplastic Syndromes and the Department of Lymphoproliferative Diseases.
Important developments exist in other areas of hematology besides malignant hematological diseases. Characteristically, Ms. Gruzi mentioned progress in the treatment of hemophilia, with new drugs that reduce the intervals of receiving treatment, from 1-2 times a week to once every ten days, as well as monoclonal antibodies against clotting factor inhibitors administered to patients, causing a revolution in the treatment of the disease and improving the quality of life of patients.
Gene therapy for both hemophilia A and hemophilia B is already an approved treatment in Europe and America.
With regard to thrombosis, issues of management of anticoagulant treatment, which is given to millions of people worldwide, will be discussed and concern the choice of the type of treatment, the duration of administration, and the treatment of major bleeding that can occur as a complication of anticoagulants . Even more important are the new data on thrombosis in hematological diseases and cancer, which is a cause of significant morbidity and mortality in these patients. Also discussed will be the management of pregnant women with thrombophilia, which is still an area of controversy.
In the field of hematopoiesis, Mrs. Bouzani also mentioned that there are new data regarding the clarification of the pathogenic mechanisms of Sickle Cell Disease and the involvement of complement, while the advent of innovative drugs creates a new landscape, which leads to a reduction in complications with a apparent reduction in the need for transfusions in patients with β-Mediterranean Anemia.
Transfusion Medicine, as Mrs. Grouzi pointed out, is a constantly evolving field of hematology, which makes it possible to perform aggressive chemotherapy regimens, hematopoietic cell and solid organ transplants, as well as major surgeries. Therefore, the transfusion of blood and its derivatives is a necessary supportive treatment for most patients with hematological diseases and not only. During the Conference, issues related to the prevention and treatment of adverse effects of transfusion will be discussed, as well as the perspectives that exist for the preparation of new platelet products and the extension of their life limit.
Vaccinations of the immunocompromised
At the conference there will be a special session on “vaccinations in immunocompromised patients”, as mentioned by Ms. Katodrytou, who show an increased risk of infections. These patients are increasing, among others, due to the use of drugs such as those against B-lymphocytes. Therefore, the issue is particularly important and was highlighted imperatively during the pandemic.
Regarding the delegates, Ms. Grouzi pointed out the Lecture of Harvard Medicine Professor Vassiliki Bousiotis, who first discovered the molecules that stimulate the mechanism of recognition and destruction of cancer cells and recently published an unprecedented discovery about the primary and until now invisible action of cancer that attacks the bone marrow from a very early stage, blocking the immune system and the ways to deal with it.
During the Conference, important announcements are expected which will be presented by distinguished Greek and foreign speakers, such as: Hermann Eibel, Theodora Foukaneli, Andrea Gallamini, Grigoris Gerotziafas, François-Xavier Mahon, Gail J. Roboz, Davide Rossi, and Jesús San -Miguel. In addition, a special session dedicated to the prospects given by the interaction of the EHA with the European Hematology Association (EHA) has been planned, in which Prof Elizabeth Macintyre (Past President of EHA) and Greek Hematologists who have participated in these actions will participate.