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Evidence-based deep dives into haematology and haemato-oncology authored by Dr. Sachita Baniya (MBBS, FCPS (Clinical Haematology), NMC 20158) — 8+ years of clinical experience in haematology and haemato-oncology with more than 1,000 bone marrow procedures. Each topic follows international guidance and links to related guides.
33 authoritative topics
All topics are authored and medically reviewed by the consultant who wrote them.
Acute myeloid leukemia (AML) is a clonal malignancy of immature myeloid cells that accumulates in the bone marrow and impairs normal blood production. Diagnosis requires at least 20% blasts in the marrow or blood in most settings, together with flow cytometric, cytogenetic and molecular characterisation. Treatment is risk-adapted and begins with induction, followed by consolidation and, for selected patients, allogeneic transplant.
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primaryAcute lymphoblastic leukemia (ALL) is a malignancy of immature lymphoid cells. It is the most common childhood cancer but also occurs in adults, where outcomes remain inferior. Diagnosis relies on marrow morphology, flow cytometry and genetic characterisation. Treatment is prolonged and includes induction, consolidation, central nervous system prophylaxis and maintenance, with allogeneic transplant for selected high-risk patients.
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primaryChronic myeloid leukemia (CML) is defined by the Philadelphia chromosome and the BCR-ABL1 fusion gene. Tyrosine kinase inhibitors (TKIs) have transformed the disease into a long-term condition for most patients. Response is assessed by blood counts and quantitative BCR-ABL1 transcript levels at defined milestones, and treatment is adjusted for intolerance, resistance or loss of response.
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primaryChronic lymphocytic leukemia (CLL) is a clonal proliferation of mature B lymphocytes. Many patients are asymptomatic at diagnosis and are monitored rather than treated. Treatment is indicated for progressive marrow failure, bulky or symptomatic disease, or rapid progression. Modern targeted agents have changed the treatment landscape, and TP53 status and IGHV mutation status inform choice.
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Measurable residual disease (MRD) refers to cancer cells that remain after treatment but are below the limit of routine morphology. MRD is measured by multiparameter flow cytometry, quantitative PCR or next-generation sequencing, depending on the disease. It informs depth of response, relapse risk and treatment decisions in leukemia and myeloma.
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primaryFlow cytometry uses antibodies against cell-surface and intracellular markers to characterise haematopoietic cells. It is central to the diagnosis of leukemia and lymphoma, plasma cell disorders and some benign cytopenias, and to measurable residual disease monitoring. Interpretation requires clinical context and correlation with morphology and genetics.
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primaryMolecular testing identifies mutations, fusions and copy-number changes that define haematological malignancies, predict response and guide targeted therapy. Cytogenetics, FISH, PCR and next-generation sequencing are used together. Results must be interpreted with morphology, immunophenotype and clinical context.
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Hodgkin lymphoma is a lymphoid malignancy characterised by Reed-Sternberg cells in an inflammatory background. It often presents with painless lymphadenopathy, sometimes with B symptoms. Staging with PET-CT and response-adapted treatment achieve high cure rates, but survivors need long-term surveillance for cardiac, pulmonary, thyroid and second-cancer risks.
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primaryDiffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma. It often presents as a rapidly growing mass and can be cured in a substantial proportion of patients with chemoimmunotherapy. Cell of origin, genetic rearrangements, stage and response assessment guide treatment, while relapsed disease may be treated with salvage therapy, transplant or CAR-T.
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primaryFollicular lymphoma is a common indolent B-cell lymphoma. Many patients are asymptomatic at diagnosis and are observed. Treatment is indicated for bulky, symptomatic or progressive disease and may include chemoimmunotherapy, lenalidomide-based therapy or other targeted approaches. The disease often relapses over years, so planning balances disease control with quality of life.
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secondaryMantle cell lymphoma is an aggressive B-cell lymphoma associated with cyclin D1 overexpression and t(11;14). It often presents with lymphadenopathy, splenomegaly and bone marrow involvement. Treatment depends on age, fitness and risk, and may include chemoimmunotherapy, BTK inhibitors, and autologous transplant in first remission for eligible patients.
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secondaryBurkitt lymphoma is a highly aggressive B-cell lymphoma with a very high proliferation rate. It may present with rapidly growing masses, abdominal disease or bone marrow involvement. Prompt diagnosis, tumour lysis prevention and intensive chemoimmunotherapy are essential. Outcomes are good when treatment is delivered without delay and toxicity is managed well.
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secondaryT-cell lymphomas are a heterogeneous group of nodal, cutaneous and extranodal lymphoid malignancies. Subtype definition requires expert pathology and sometimes molecular studies. Treatment is subtype-specific and may include chemotherapy, targeted agents, radiotherapy, transplant or clinical trials. Relapsed disease remains a major challenge.
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Multiple myeloma is a malignancy of clonal plasma cells that causes bone disease, anaemia, renal impairment, hypercalcaemia and immune suppression. Diagnosis requires clonal plasma cells plus myeloma-defining events. Treatment combines proteasome inhibitors, immunomodulatory drugs, steroids, antibodies and, for eligible patients, autologous transplant. MRD assessment is increasingly used.
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primaryMonoclonal gammopathy of undetermined significance (MGUS) and smouldering multiple myeloma are precursor plasma cell disorders. MGUS has a low annual risk of progression; smouldering myeloma has a higher risk that varies with disease burden and genetics. Most patients are monitored, while selected high-risk smouldering cases may be offered treatment or trials.
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secondaryAL amyloidosis is caused by a clonal plasma cell population producing misfolded light chains that deposit in tissues. It can affect the heart, kidneys, liver, nerves and gut. Diagnosis requires tissue confirmation with Congo red staining and typing, plus a search for the plasma cell clone. Treatment aims to suppress the clone and preserve organ function.
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secondaryWaldenström macroglobulinaemia is an indolent lymphoplasmacytic lymphoma associated with an IgM monoclonal protein. It may cause anaemia, lymphadenopathy, hyperviscosity, neuropathy or cryoglobulinaemia. MYD88 and CXCR4 mutation testing informs treatment, which is reserved for symptomatic or progressive disease.
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Myelodysplastic syndromes (MDS) are clonal marrow disorders characterised by ineffective haematopoiesis, cytopenias and dysplasia, with a variable risk of progression to acute myeloid leukemia. Diagnosis integrates blood counts, marrow morphology, cytogenetics and molecular findings. Treatment is risk-adapted and ranges from observation and supportive care to hypomethylating agents and transplant.
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primaryMyeloproliferative neoplasms include polycythaemia vera, essential thrombocythaemia and primary myelofibrosis. They share JAK2, CALR or MPL mutations and a risk of thrombosis, bleeding and progression to myelofibrosis or acute leukemia. Treatment focuses on symptom control, thrombotic risk reduction and surveillance for transformation.
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secondaryAplastic anaemia is a bone marrow failure disorder causing pancytopenia due to immune-mediated destruction of haematopoietic stem cells. Diagnosis requires marrow hypocellularity and exclusion of other causes. Treatment includes supportive care, immunosuppressive therapy and allogeneic transplant, selected by age, severity and donor availability.
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Autologous transplant uses the patient's own haematopoietic stem cells to rescue marrow function after high-dose chemotherapy. It is used in selected patients with myeloma, relapsed lymphoma and some other haematological cancers. The process includes mobilisation and collection, conditioning, reinfusion and close monitoring for infection and organ toxicity.
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primaryAllogeneic transplant replaces a patient's haematopoietic system with donor stem cells. It provides a graft-versus-disease effect and is used in selected high-risk leukemias, myelodysplastic syndromes, bone marrow failure and other disorders. The procedure carries substantial risks, including graft-versus-host disease, infection and organ toxicity, and requires long-term follow-up.
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primaryHaplo-identical transplant uses stem cells from a half-matched donor, usually a parent, child or sibling. Modern conditioning and post-transplant cyclophosphamide-based GVHD prophylaxis have made this approach widely available. It is an important option for patients without a fully matched donor, but infection and GVHD risks remain significant.
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primaryGraft-versus-host disease (GVHD) occurs when donor immune cells attack recipient tissues after allogeneic transplant. Acute GVHD usually affects skin, gastrointestinal tract and liver; chronic GVHD can affect multiple organs. Prevention, early recognition and prompt immunosuppressive treatment are essential.
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Immune thrombocytopenia (ITP) is an acquired immune-mediated reduction in platelets. It causes bruising, petechiae and sometimes mucosal or intracranial bleeding. Diagnosis is clinical and excludes other causes. Treatment depends on bleeding severity and platelet count, and may include observation, corticosteroids, intravenous immunoglobulin, anti-D and newer agents.
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secondaryThrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy caused by severe ADAMTS13 deficiency. It presents with thrombocytopenia, microangiopathic haemolytic anaemia and organ ischaemia. It is a medical emergency requiring urgent plasma exchange and specialist care.
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primaryIron deficiency anaemia is the most common anaemia worldwide. It results from insufficient iron intake, impaired absorption or blood loss. The evaluation must identify the cause, especially gastrointestinal blood loss, and not simply replace iron. Treatment combines cause-directed management with iron replacement.
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secondaryThalassaemias and sickle cell disease are inherited haemoglobin disorders. Thalassaemia major requires lifelong transfusion and iron chelation; sickle cell disease causes vaso-occlusive episodes, haemolysis and organ complications. Care combines specialist follow-up, prevention, vaccination and family screening.
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secondaryHaemophilia A and B are X-linked deficiencies of factor VIII and IX; von Willebrand disease is the most common inherited bleeding disorder. Diagnosis requires factor assays and careful history. Management includes factor replacement, antifibrinolytics, desmopressin in selected cases, and preventive planning for surgery or pregnancy.
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Authority topics are structured, evidence-based deep dives into specific haematology and haemato-oncology conditions. Each topic is authored and medically reviewed by Dr. Sachita Baniya (MBBS, FCPS (Clinical Haematology)), drawing on 8+ years of clinical experience in haematology and haemato-oncology of clinical practice, with outpatient consultation at Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, and hospital practice at Kathmandu Cancer Center (KCC) Nepal, Civil Service Hospital, Kathmandu, and Advanced Care Hospital.
Topics follow international classifications and guidance — WHO and ICC haematolymphoid classifications, European LeukemiaNet recommendations, NCCN guidelines, and EBMT/ASCO transplant and cellular-therapy standards. They are designed to help patients and families understand a diagnosis, prepare for consultations, and have informed discussions with their haematologist or haemato-oncologist.
Blood cancers and complex blood disorders involve tests and treatment decisions that are difficult to interpret without specialist context. Authority topics provide a single, reliable reference point covering diagnostic criteria, risk stratification, treatment phases, transplant and CAR-T pathways, and supportive care — so patients can ask better questions and follow their care plan with confidence.
Each topic is authored by a consultant haematologist-haemato-oncologist with 8+ years of specialist experience and more than 1,000 bone marrow procedures, follows international classifications and guidelines (WHO/ICC, ELN, NCCN, EBMT), and lists its clinical references. Content links to related condition guides, services and the doctor's profile.
No. These topics are educational and designed to help you understand conditions, prepare for appointments, and have informed discussions with your clinician. Diagnosis of a blood disorder requires blood counts, bone marrow examination, flow cytometry and molecular testing interpreted in clinical context — none of which can be replaced by reading alone.
Dr. Sachita Baniya (NMC 20158) consults at Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, and also practises at Kathmandu Cancer Center (KCC) Nepal, Civil Service Hospital, Kathmandu, and Advanced Care Hospital. Appointments are arranged at the Durbar Marg clinic or through the respective hospital or cancer centre.
Content on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.