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What happened in the world of haematology in the latter half of the last millennium and how has this been reflected in the pages of JCP? A sample, chosen by me, of a few papers published early, somewhat later, and much more recently in the Journal's publishing history will certainly illustrate my enthusiasms, even if they will not answer either question satisfactorily for many haematologists.
In the very early days, Dacie and White1 published a review (in those days reviews were often both scholarly and truly elegantly written affairs, and this is such an example) of erythropoiesis and its study by bone marrow biopsy. I know microscope lenses and condensers have improved enormously since then, as has modern colour photography, but the careful observation and descriptive power of conscientious microscopists still shines through. Observation of snapshots of this dynamic organ was really all that was available because bone marrow culture systems, as we know them today, would have been science fiction to haematologists in the 1940s. It is also fascinating to see the sang froid with which haematologists in those days would contemplate and perform a trephine biopsy on the sternum!
Massive leaps in the technology of cell counting, understanding of clotting, and other areas took place between 1949 and the 1970s. However, although I remain at heart a morphologist, it is the more “basic biology” advances (especially as they affect malignant haematology) that have really gripped my imagination. In 1975 Habeshaw and Stuart2 reported on cell receptor studies in histiocytic lymphoma, still called reticulum cell sarcoma in those days. Their paper illustrated the way early techniques of sheep red cell rosetting and fluorescence microscopy with polyclonal antibodies could be used to determine T, B, or null phenotypes from single cell suspensions of these lymphomas. Of course such techniques had already been used for a few years by pure immunologists and early classifications, of childhood leukaemia in particular, were already being compiled. The dawn of the true expansion of immunological diagnosis is reflected, six years later, in the review by Hoffbrand and Janossy.3 Not only had the common acute lymphoblastic leukaemia antigen been discovered by Greaves, but Ritz had produced a monoclonal antibody to it, one among an expanding battery of monoclonal antibodies to T, B, and myeloid cells to come out of numerous laboratories round the world. The speed with which such reagents entered routine diagnosis was extraordinary. The size of antibody panels soon demanded flow cytometry, both for the improved accuracy that came from analysing large numbers of fluorescing cells and in order that fluorescence microscopists were not submerged by the deluge.
The last 10 years have witnessed a similarly breathtaking explosion in what was once called “the new genetics.” DiGiusseppe and Kastan4 provided, in 1997, a review of apoptosis in haematological malignancies which explored current knowledge of the action of a number of genes such as bc1-2, p53, Fas, and perhaps the most extensively and longest studied genetic rearrangement, the fusion gene BCR/ABL—and of the effects they might have on programmed cell death and resistance to chemotherapy. Molecular biological knowledge is now expanding faster than haematologists can assimilate it; we can barely begin to frame the important questions about how best to exploit this knowledge, let alone answer those questions. My feeling is that over the next 20 years we shall discover just how difficult it really is to harness these discoveries and decide which are truly important to our every day management of haematological malignancy. In the meantime it's a field day for the basic scientists!