Clinical Review

ABC of clinical haematology: The future of haematology, molecular biology, and gene therapy

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7091.1396 (Published 10 May 1997) Cite this as: BMJ 1997;314:1396
  1. Adele K Fielding,
  2. Sally Ager,
  3. Stephen J Russell

    Introduction

    This article will assess the impact of advances in science and technology on the practice of haematology and attempt to predict how haematology will change further over the next 10 to 15 years.

    The future of haematology–diagnosis and treatment

    Diagnosis
    • Increasing automation giving quicker and more reliable results–eg automated cross matching; automated diagnostic polymerase chain reaction

    • More DNA/RNA based diagnosis, allowing increased diagnostic precision–eg precise definition of genetic abnormalities; diagnosis with polymerase chain reaction

    • More “near patient” testing, allowing rapid screening–eg haemoglobinometers, monitoring of anticoagulant treatment

    Treatment
    • New drugs–eg tailored to molecular abnormalities

    • New biological agents–eg thrombopoietin, which may speed platelet recovery after chemotherapy

    • Transplantation across tissue barriers–eg cord blood transplantation

    • Blood substitutes–eg recombinant haemoglobin

    • Gene therapy–probably for many haematological disorders

    The major advances in scientific thought and technological development that have already changed the practice of modern haematology are likely to affect both laboratory diagnosis and treatment in the future. This article will address three specific area of haematology–anaemia, haemophilia, and leukaemia–and explain how important innovations could be expected to change clinical practice in these areas. The article begins, however, with an overview of gene therapy, which, although currently some way from curing haematological diseases, is likely to have a role in most areas of haematological practice in the future.

    Both diagnostically and therapeutically, the identification of the molecular pathology of the underlying disorder will continue to steer the future, but the ability to make more accurate diagnoses has not yet resulted in improved treatment.

    Gene therapy

    The term gene therapy is applied to any manoeuvre in which genes or genetically modified cells are introduced into a patient for therapeutic benefit. Gene therapy is still in its infancy, and despite the potential of the approach, clinical benefit has yet to be shown.

    Successful gene therapy depends on the availability of reliable methods for delivering a gene into the nuclei …

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