Palliative care in haematology

Haematologists and their patients are enjoying something of a golden era of late. With the stunning success of Imatinib (Novartis, Australia) for chronic myeloid leukaemia, it is estimated that responding patients have a prognosis of more than 20 years. The overall survival for younger patients with multiple myeloma eligible for dose-intensified therapy has significantly improved. Treatments for the common types of non-Hodgkin lymphoma (NHL) have also improved with the addition of rituximab to CHOP (Cyclophosphamide; Doxorubicin; Vincristine; Prednisone) chemotherapy. The event-free survival at 3 years for diffuse large cell lymphoma is now approaching 80% in those less than 65 years of age and 60% in the elderly. For the first time in recent years we have seen a shift in the survival curve in follicular low grade NHL. Of course, Hodgkin lymphoma and paediatric acute lymphoblastic leukaemia remain our greatest successes and in recent years therapeutic strategies have concentrated on achieving the same or better cure rates with less long-term toxicity.