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Book and Media Reviews
October 26, 2011

Management of Hematologic Malignancies

Author Affiliations

Author Affiliation: Department of Internal Medicine, Hematology/Oncology, University of Arkansas for Medical Sciences, Arkansas Veterans Healthcare System, Little Rock (mehtapaulette@uams.edu).

JAMA. 2011;306(16):1806-1807. doi:10.1001/jama.2011.1549

Hematologic malignancies comprise only approximately 10% of all cancers, but the incidence of these malignancies is increasing, even as the incidence of many nonhematologic cancers (eg, lung and breast cancer) is decreasing. The incidence is expected to continue to increase as the population ages.

The past several years have brought remarkable advances in the field of hematologic malignancies. Diagnosis is increasingly based on sophisticated molecular techniques, and diseases are increasingly defined by biological characteristics rather than morphology or anatomy. Such advances have resulted in a much clearer understanding of the pathogenesis of hematologic malignancies and have created a framework within which to develop targeted therapies against the specific mutated genes that cause disease. The disease often used as an example for such targeted therapy is chronic myelogenous leukemia, in which treatment targets the malignant bcr-abl clones while sparing normal hematopoietic and other cells. This has resulted in simpler, less toxic, and more successful outcomes than ever before achievable. Even in this setting, however, new problems have arisen with resistance to first-line tyrosine kinase inhibitors attributable to detectable mutation patterns. This complication has been largely overcome by development of even more potent second-, third-, and fourth-line inhibitors. New protocols are arising using combination therapy of different targeted and nontargeted therapies, providing hope for the possibility of cure.

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