EDUCATION
Meet the Munich Leukemia Laboratory : Using Modern Technology to Find Clues to Hematologic Mysteries
● At its core , the Munich Leukemia Laboratory ( MLL ) is like any other diagnostic lab .
“ We receive samples and send reports ,” one of its three cofounders , Torsten Haferlach , MD , PhD , told ASH Clinical News . “ It is basic stuff from that perspective .”
The day-to-day operations of the MLL , however , are anything but basic . Through automation , cloud computing , artificial intelligence , and state-of-the-art molecular diagnostics , the lab can process patient genome data in 3 hours – a huge step forward from the 13 years it took to map the first human genome .
The MLL ’ s mission is to improve the care of patients with leukemia and lymphoma through cutting-edge diagnostics . To do this , the lab uses an interdisciplinary approach combining six disciplines – cytomorphology , immunophenotyping , chromosome analysis , fluorescence in situ hybridization ( FISH ), molecular genetics , and bioinformatics – resulting in one comprehensive integrated laboratory report .
“ In hematology , we are on the way to defining malignant diagnoses in much more detail , putting us 5 to 10 years ahead of solid tumor diagnostic tools ,” Dr . Haferlach said . “ We are working toward specific breakdowns of morphology and genetics to better classify leukemias and lymphomas to aid in classification of disease and improving targeted treatments .”
And their work has only just begun . ASH Clinical News spoke with MLL ’ s cofounders about their innovative approach to leukemia and lymphoma diagnostics and their vision for the future .
Branching Out
The MLL opened in August 2005 to address advancing leukemia diagnostics . Dr . Haferlach , along with cofounders Claudia Haferlach , MD , and Wolfgang Kern , MD , recently celebrated the lab ’ s 15 th anniversary – although , due to COVID-19 , not with the party its founders would have liked .
“ We realized [ 15 years ago ] that the need for diagnostic tools and combination methods was increasing quickly and there was no space for us within a university infrastructure to expand our lab and hire new personnel ,” Dr . T . Haferlach said of the motivation behind creating the MLL . “ We moved out of the quiet , comfortable zone of a university hospital into a private setting that combined a private lab with a hematology practice .”
In the 15 years since its opening , the MLL has processed more than 750,000 samples from settings throughout the world . The number of employees has grown from just 29 to more than 200 . Dr . T . Haferlach is Head of the Cytomorphology Department , Dr . C . Haferlach is Head of the Cytogenetics and FISH Department , and Dr . Kern is Head of the Immunophenotyping Department . Manja Meggendorfer , PhD , MBA , is Head of Molecular Genetics and Research and Development at MLL , which represents the fastest-growing segment of the lab ’ s work .
Smooth Operations
The unique advantage of the MLL is its interdisciplinary approach . Rather than sending samples to five different laboratories that perform five types of testing spread across five cities , clinicians can take advantage of several types of testing housed in a single lab , Dr . T . Haferlach explained .
The MLL also sets itself apart by hiring not only lab scientists , but also hematologists .
“ Each sample we receive is reviewed by one of our hematologists to see if the ordering physician is asking the right questions ,” Dr . Kern said . “ This means that we occasionally change the workflow of the sample and take the opportunity to work with the
[ test-ordering ] hematologist and say , ‘ You can ask that question , but we suggest you ask this question instead .’”
The upfront collaboration , called “ order control ,” avoids unnecessary diagnostics and wasted time and money , making the whole diagnostics process quicker and cheaper .
When a sample arrives at the MLL , it enters a world of extensive automation and digitization . It is added in the MLL ’ s database , then labeled with a barcode unique to each patient ’ s blood or bone marrow , and finally forwarded for cell lysis for amplification .
Next , robots divide the samples into equal portions and place them in barcode-labeled vials . These vials are automatically frozen in large refrigerator units . The next morning , the robot automatically retrieves these vials for further analyses in a 96-well plate format .
Other machines prepare the DNA , and another set of devices prepare the samples for sequencing machines . The barcode assigned to each sample can be read at all workstations and devices throughout the lab . The lab ’ s database is automatically updated as the sample is transferred between staff and equipment , allowing anyone
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