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25th November 2024
Professor Antonio Almeida has been at the forefront of clinical haematology for more than 20 years and last year he became president of the European Hematology Association (EHA). Speaking to Julie Penfold, he shares his plans for his second year as EHA president, key takeaways from June’s EHA Congress and his insights into the future of clinical haematology.
There’s never a dull moment when specialising in the field of haematology, with near-constant clinical developments emerging and an abundance of reasons to be optimistic for the future of patient care and outcomes.
‘Haematology is a very exciting specialty,’ explains Professor António Almeida, head of department at Hospital da Luz in Lisbon, founding dean of Portugal’s Catolica Medical School, and president of the European Hematalogy Association (EHA).
‘I think we are certainly a specialty in which scientific innovation hits the clinical ground very, very fast. And even now, when we know so much about genetic mutations, new treatments and targeted treatments, we’re always discovering new pathways for patients and promising treatment options.’
He adds: ‘Not only are we now targeting the genetic landscape but we’re also targeting all the immunological and all the microenvironments that surround the diseases. It really makes haematology a crest-of-the-wave type of specialty.’
One of Professor Almeida’s main aims when he took up the role of EHA president in 2023 was to foster greater recognition of haematologists throughout Europe. As such, the EHA has been working hard to promote the specialty within the European Union and with national authorities and societies.
‘Haematology is a very diverse subject, and we range from a huge variety of diseases from coagulation to benign to malignant, and from a huge range of activities from clinical to laboratory to research,’ Professor Almeida explains. ‘That’s why it’s really important with this diversity that people are recognised for their specialty.’
To reflect this diversity and demonstrate how the field is evolving, EHA shared a new vision statement at its 2024 congress, alongside the rollout of a new brand identity. The previous iteration of the vision statement, ‘Towards a cure for all blood diseases’, has been adapted and now reads: ‘Towards prevention, cure and quality of life for all patients with blood disorders’.
Professor Almeida explains that it was important for the vision statement to be updated as ‘many of our diseases are becoming chronic and not necessarily cured’. In addition, there was an agreement within the association for it to evolve to reflect ‘what our members would identify with’ in their day-to-day practice when supporting a variety of patients with differing needs and outcomes.
‘We really want to cater for the whole population including those who have chronic disease and the burden of chronic disease. We want to make sure that they really have their needs addressed and that we can look at preventing certain diseases too,’ Professor Almeida says.
‘For example, how can we improve screening, and how can we improve the quality of life of patients [who] are on chronic therapies and have side effects but want to continue living a normal life? How can we ensure their symptoms are mitigated? I think this is how the vision statement really translates into clinical practice. It’s fundamentally addressing the day-to-day needs that haematologists and patients have.’
Two other key aims for Professor Almeida’s presidency are to increase EHA members’ involvement in the association and for the EHA to become more active in promoting research. Both of these ambitions have progressed well, Professor Almeida says.
For example, at the EHA Congress in June 2024, more than 18,000 people attended – the biggest number yet for this annual event. ‘What we have seen with the greater participation of members at Congress is really the way forward that we’re working towards – that is to have members more involved and to be able to support them with new research grants and more educational offers, so they feel that the EHA is helping both their careers and practice in haematology,’ Professor Almeida says.
This is particularly important as Professor Almeida notes significant variations in funding for haematology research across Europe. ‘It’s very, very important that we recognise that most of the research grants and most of the research happens in the top five countries and the rest ends up not having much access,’ he explains. ‘Promoting research and facilitating access to research is a big flagship that we’re going to move forward with.’
As part of these efforts, over 3,000 abstracts were submitted for this year’s Congress, which was another record high, and this is something that Professor Almeida is particularly proud of. ‘This meant we had top quality work being presented and the haematology communities are now really looking at EHA Congress as one where they want to present their work,’ he explains. ‘We had presentations of trials that really are changing practice both in malignant oncology and also in benign oncology.’
For Professor Almeida, one of his personal highlights at the Congress was the scope of the presidential sessions. ‘Not only did we have oncology, coagulation and red cell diseases, but we also had a lot of innovation and translational science touching clinical, which was particularly exciting,’ he explains.
Another highlight was a talk on sickle cell disease, looking at how the landscape has changed with new emerging therapies such as anti-sickling agents and antibodies. He recalls: ‘It’s really changing the outlook for patients with sickle cell disease and helping us decide where we should be treating, who we should be treating, and who we should be aiming to change therapies in.’
A session on coagulation looked at how pregnant women can be treated with anticoagulants and what the evidence is, which Professor Almeida found both interesting and helpful. ‘In general haematology, we get lots of referrals about this area so it could make a difference for these patients,’ he says.
While the EHA Congress highlighted significant progress and innovations that have the potential to revolutionise the care of blood disorders, it also underlined the ongoing challenge of managing haematology patient needs as their conditions change and, at times, worsen.
‘How we deal with patients that have relapsed multiple times, and how we deal with patients with chronic disease is now really becoming a big challenge,’ says Professor Almeida. ‘The way that we’re tackling this is really by reducing side effects and by trying more and more to reduce toxicity. For example, stopping certain treatments, if that’s an option; looking at ways of reducing doses; and improving combinations so that patients experience [fewer] side effects from their treatments.’
In chronic myeloid leukaemia, for example, many treatments are available, and each have different side effect profiles. Professor Almeida says clinicians are increasingly tailoring these treatment choices to optimise patients’ care. ‘We can choose which treatment to use based on what the disease presents but also what the patient is most likely to have as a side effect profile and [we can] avoid this to minimise the toxicity,’ he says.
Targeting treatments to specific mutations in certain diseases is also becoming a reality. Professor Almeida says: ‘With this, we are moving more and more towards personalised medicine in which patients can be treated not only for their disease specificities, but also for their own specificities.’
This personalisation of care is only set to improve as the use of technology in haematology is anticipated to really take off. Professor Almeida believes this will include the escalation of using artificial intelligence within clinical trials and using registry and synthetic data to determine the best treatment aims for patients.
‘I think we will also see the advent of new therapies to look at and modulate the immune system to treat all sorts of blood disorders,’ Professor Almeida suggests. ‘We’ve seen this very effectively in CAR T-cells in lymphomas, and I’m sure we will see this in other haematological diseases, and it’ll certainly make a huge difference for patients.’
18th September 2023
Advances in technology mean that moving from microscopes to digital alternatives can now be achieved without sacrificing image quality. Here, Professor Gina Zini reflects on the wide-reaching benefits of digital developments in morphology including time savings for busy morphologists, improved clinical collaboration, enhanced training and sharing expertise with developing countries.
When I started my career as a haematologist, examining a blood smear meant looking through a microscope. This was the standard throughout the world.
Advances in technology have since led to the development and deployment of new approaches in many countries. In particular, digital tools have played increasingly supportive roles, often replacing or reducing the need for many manually intensive tasks in laboratories.
The potential for digital, particularly in areas such as haematology and morphology where I specialise, is now expanding further as more sophisticated technologies continue to be introduced. The aims: to improve efficiency, quality and collaboration in an environment where scarce professionals are in high demand.
Digital morphology analysers have been adopted in many parts of the world as one means to improve efficiency in the laboratory, as well as the quality of reporting in screening programmes. Such devices have helped to automate parts of the screening process, analysing large quantities of blood smears to help to identify abnormalities.
Technology certainly hasn’t replaced the role of haematologists. Human interaction still plays a very substantial role in screening programmes, with haematologists intervening when cases are flagged, and validating significant samples in an ongoing process to help to ensure accuracy and reliability.
Modern digital morphology analysers have allowed professionals in the laboratory to view, validate and report from images on screen, enabling them to more easily find cells and areas of concern than if they were looking through a microscope.
Recalling images on the screen, compared to searching for the cells on a slide under the microscope, also represents a great advantage in terms of both the necessary time and effort for busy laboratory teams.
The on-screen availability of digital cellular images has facilitated intra-laboratory, and sometimes inter-laboratory, consensus and harmonisation, with images easily accessible and searchable for teams who are onsite and those working remotely.
Access to digital images can, for example, allow staff to share images with other colleagues for expert opinion, even if that colleague is working at home.
Additional gains have also been presented by digital technologies. A blood smear can sometimes provide the primary, or the only, evidence of a specific diagnosis, such as myelodysplastic syndrome, leukaemia, lymphoma or haemolytic anaemia. Such blood smears may need to be stored over the long term, which is more easily achievable with digital morphology images.
For some abnormal parameters provided by the automated analysers, such as red blood cell abnormal parameters, accuracy can be higher and less subjective than grading using microscopy. This can help staff to deliver important reports after conducting only a rapid qualitative assessment of the smear.
In short, digital morphology has been delivering significant advantages in laboratories seeking to improve turnaround times, quality and costs, helping to alleviate some of the fatigue and workload challenges associated with optical morphology and improving the opportunity for repeatability and the easier management of cell images.
The need for highly capable digital tools has now intensified. Their role is transforming from supporting the efficient business of the laboratory to one of an urgent necessity for screening services under pressure.
There is now a crisis of human resources in fields like haematology and morphological analysis, fuelled by the availability of fewer experts each year, who continue to manage an ever-increasing workload to support preventative healthcare. The situation now requires even better technologies to augment capacity.
Digital morphology analysers represent an important example of technology that has evolved to support this, and where innovation continues.
Historically, though helpful, older devices have presented some limitations. Many of these devices have worked by rebuilding an image rather than displaying a true image of the smear. This means that images appear differently to those seen on glass slides through optical microscopy.
Consequently, laboratory teams reviewing an image have needed additional training to be taught how to interpret images and recognise areas of concern from images produced by specific devices, in order to be able to report in an effective and consistent manner.
This is now changing. New digital technologies are able to reproduce precisely what is seen under a microscope, allowing clinicians to immediately check and validate the images on the screen.
There is no need for any additional time to locate the slide, position it on the microscope table, search for the observation and counting area, focus with objectives at different magnifications including the addition of oil, as occurs when working with an optical microscope.
Time spent is dedicated to observing the cells and confirming their pre-classification or moving to a different subclass, when necessary. After the movement, the system will automatically regenerate the percentages of the differential, which also significantly reduces the amount of time it would have traditionally taken.
This ability to create images that are indistinguishable from the microscopy view is state of the art. Efficiency gains and support for better quality reporting are benefits that speak for themselves in the context of stretched resources.
But it also opens up new possibilities around training and collaboration. Digital morphology can, in general, reduce the time it takes to train a good morphologist. But it is also worth bearing in mind that despite growing adoption, only around 37% of the world uses digital morphology. Many developing countries, for example, still rely on microscopy as their primary tools.
Having access to technologies that can reproduce an image as seen under a microscope, opens immediate opportunities for laboratories using digital morphology to share recognisable images for training purposes with professionals and trainees in countries where the technology is not yet widely used.
And if we can increase adoption of digital morphology that produces images familiar to those who use microscopy, opportunities to improve screening, reduce false negatives and extend the many other benefits that digital morphology can bring could be realised.
Professor Gina Zini is an associate hematology professor at Università Cattolica del Sacro Cuore, and Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome, Italy. She is also a board member and past scientific secretary (2012-22) at the International Council for Standardization in Hematology. Professor Zini has recently contributed to a performance analysis for the MC-80 automated digital cell morphology analyser launched by medical device provider Mindray.
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