Chapter 12: Management of Haematological Malignancy

The management of haematological malignancies involves a sophisticated dual approach focusing on comprehensive supportive care and specialized pharmaceutical interventions designed to reduce tumor burden. Clinical assessment prior to treatment is vital, utilizing performance scales to gauge a patient's functional abilities alongside evaluations of cardiac, pulmonary, and renal health. Central to supportive care is the use of specialized vascular access devices like tunnelled catheters or implanted ports, which facilitate the delivery of vesicant chemotherapy and various blood products. Transfusion protocols for red cells and platelets are meticulously managed to address anemia and thrombocytopenia while minimizing risks such as hyperviscosity or circulatory overload. Managing infection remains a primary challenge due to the profound immunosuppression caused by both the disease and its treatment; thus, protocols involve vigilant monitoring for fever, the use of broad-spectrum antibiotics, and prophylaxis against viral reactivations and invasive fungal species like molds or yeasts. Additionally, clinicians must proactively manage systemic complications such as tumor lysis syndrome, which causes dangerous shifts in electrolytes, and address the multifaceted needs of the patient through nutritional support, pain management, and reproductive health counseling. The therapeutic arsenal has expanded from traditional cytotoxic agents—including DNA-disrupting alkylating agents, antimetabolites, and cytotoxic antibiotics—to precision-targeted drugs. Modern strategies utilize signal transduction inhibitors to block specific protein pathways, monoclonal antibodies to target surface antigens, and epigenetic modifiers to alter gene expression. High-tech immunological treatments such as immune checkpoint inhibitors and bioengineered T-cell therapies represent the cutting edge of care, offering hope for resistant cancers by directing the immune system to recognize and destroy neoplastic cells, despite the risk of severe side effects like systemic inflammatory responses and neurotoxicity.