Posted on 25 March 2014
Accounting for around 1 in 10 of all newly diagnosed cancers in the UK, traditional diagnostic tests place the various haematological malignancy sub-types into one of around 25 standard categories, and these in turn are used to determine treatment. However, the boundaries between many categories are blurred and ill-defined, resulting in “grey zones” and significant clinical uncertainty. Treatment of patients within these zones is neither clear nor straightforward, and it is possible that some patients are not receiving the best choice of treatment.
Haematological malignancies are at the forefront of much cancer research, with new scientific advances relating to the increasing availability of relatively low-cost, high-throughput mutational analysis and gene expression profiling resulting in an expansion of prognostic tumour biomarkers. By combining conventional diagnostic and prognostic information with these more detailed biological data, this study aims to introduce a more personalised category-free approach to the diagnosis and treatment of cancer.
Focussing in the first instance on three of the non-Hodgkin lymphomas (diffuse-large B-cell, follicular and Burkitt’s), the project is embedded within Yorkshire’s Haematological Malignancy Research Network (www.hmrn.org), established in 2004 by University of York researchers and NHS clinicians with the aim of providing generalisable data to inform clinical practice and research. If successful, the techniques used in this project - which will provide the basis for a more useful guide to the types of cancer these patients have as well as the best treatments for them - will be applied to other cancer types.
Set within the former adjacent Cancer Networks of Yorkshire and the Humber and Yorkshire Coast, HMRN’s catchment population (>3.6 million) has a similar socio-demographic profile to the country as a whole, and patient care is provided by a unified clinical network operating across 14 hospitals organised into five multi-disciplinary teams (MDTs) that work to common guidelines. Importantly, all diagnoses (>2,200 new patients a year), including disease progressions and transformations, are coded to the latest WHO classifications by clinical staff at a single integrated haematopathology laboratory that houses all of the relevant technology and expertise required for diagnosis and on-going monitoring; cited in the UK’s Cancer Reform Strategy as ‘the model for delivery of complex diagnostic services’.
Within HMRN, all patients have full treatment, response and outcome data collected to clinical trial standards and the study operates with Section 251 support under the NHS Act 2006, enabling the Health and Social Care Information Centre (HSCIC) to provide us with nationwide information on deaths, cancer registrations (preceding and succeeding), and Hospital Episode Statistics (HES) for all patients.