Shining a light on blood cancer: An interview with Dr Carlos Mendes, Unilabs Clinical Pathology Medical Specialist

Blood cancers affect millions of people worldwide, presenting unique challenges in diagnosis, treatment, and management. To shed light on this important topic, we sat down with Dr Carlos Mendes, Unilabs Clinical Pathology Medical Specialist, to gain insights into the intricacies of blood cancer diagnosis and the advancements shaping its landscape.

Blood cancers encompass a diverse range of diseases, each with its own characteristics and challenges. Can you provide our readers with an overview of the different types of blood cancer and their prevalence?

Haematological neoplasms include a wide range of diseases that affect blood cells, bone marrow, and lymphoid organs. Normally, bone marrow produces blood progenitor cells that, over time, develop into mature cells. Leukaemia occurs when the bone marrow produces many altered cells of specific types of white blood cells called myeloblasts. These leukaemic cells are dysfunctional, multiplying in the marrow and released in blood, and over time, they accumulate, replacing normal blood cells and affecting normal cellular function. The presence of more than 20% blast cells in the peripheral blood or bone marrow is the criterion for defining leukaemia. Patients experience weakness, muscle fatigue, recurrent infections, and bleeding. Leukaemia is diagnosed by a complete blood count with cellular morphology, bone marrow aspiration, and biopsy. Immunohistochemistry and flow cytometry specify the type of leukaemia. Cytogenetics and molecular tests provide valuable additional information for risk group classification, treatment, and prognosis. 

The primary types of leukaemia are acute myeloid leukaemia (AML), acute lymphoblastic leukaemia (ALL), and chronic lymphocytic leukaemia (CLL).

As a specialist in blood cancer diagnosis, what are some of the primary challenges you encounter in your practice?

Onco-haematological diseases encompass a wide range of diseases due to their heterogeneity, with unique morphological, immunophenotypic, genetic, molecular, and clinical characteristics. Accurate diagnosis requires significant experience and a deep understanding of haematological pathology.

The diagnosis requires a comprehensive approach starting with the patient's clinical context, including the morphological analysis of peripheral blood in the complete blood count, imaging tests, bone marrow aspiration, and sometimes biopsies of both bone marrow and lymph nodes. All of this interpretation requires extensive experience and specialised knowledge.

With the continuous advancements in diagnostic technology, how have you seen the accuracy and efficiency of blood cancer diagnosis improve over the years? Are there specific diagnostic techniques or tools that you find particularly useful in your practice for diagnosing blood cancer?

With the advent of digital morphology, multiparameter flow cytometry, cell sorting, next-generation sequencing (NGS), and artificial intelligence, diagnosis and prognosis have become much more precise in selecting therapies.

The introduction of RT-PCR, digital PCR, and comparative genomic hybridisation tests is now used to detect specific genetic alterations associated with different subtypes of onco-haematological diseases. All of this helps in the personalisation of therapeutic regimes on the path to precision medicine.

Laboratory tests have significantly increased their sensitivity and specificity across the board.

Collaboration among healthcare professionals is essential in providing comprehensive care for patients with blood cancer. How do you collaborate with other specialists, such as oncologists, to ensure holistic patient management?

Sharing the results of laboratory tests, complete blood counts, bone marrow aspirate analyses, bone marrow biopsies, cytogenetics studies, and molecular studies with oncologists is our daily practice.

Monitoring medication toxicity signs to adjust dosage is carried out and shared.

We also participate in multidisciplinary meetings, where oncologists, haematologists, pathologists, and other specialists gather to discuss complex cases, treatment options, and decision-making.

We increasingly use clinical information systems and data analysis tools to integrate clinical, laboratory, and genomic data, enabling a more comprehensive approach to diagnosis. This facilitates collaboration between multidisciplinary teams and aids in clinical decision-making.