One person is diagnosed with blood cancer approximately every three minutes, according to the Leukemia and Lymphoma Society. And about every nine minutes, someone in the United States dies from blood cancer. It is one of the world’s most dangerous cancers.
There are several types, but the most common include acute leukemias, chronic leukemias, non-Hodgkin’s lymphoma, Hodgkin’s disease and multiple myeloma.
Dr. Paul Shaughnessy, medical director of Methodist Hospital’s Adult Blood and Marrow Transplant Program, said blood cancers are usually diagnosed when there are abnormalities in blood count. This might be white blood cells that are elevated or very low, or when someone is anemic or has bleeding issues.
“People can feel very tired, fatigued, have increased lymph nodes, fevers or signs of infection,” Shaughnessy said. “Through physical exam and checking blood counts, we can often suspect there might be a form of blood cancer. Then, diagnostic tests can be done -- such as a bone marrow biopsy or a lymph node biopsy -- to confirm the diagnosis and allow us to make prognosis and to set treatment plans.”
There can be a multitude of reasons why someone might be especially fatigued for a period, but Shaughnessy said when it’s ongoing and coupled with fever, swollen lymph nodes and easy bruising or bleeding, that could be a red flag that something more is going on.
Who’s at risk?
Shaughnessy said blood cancer in adults is typically brought on by damage from environmental factors as we age.
“For most adults with blood cancers, the risks are things like hydrocarbon exposure, benzines, pesticides, herbicides and agent orange exposure -- toxins that damage DNA and vital cells. If our body cannot repair this damage, it can lead to the development of cancers.”
He said most adults with these blood cancers were not born with it and they don’t pass these cancers down to children, but there are some genetic risks that can predispose younger people to blood cancer.
“Some of these cancers that are very rare, we can find those genetic risks when we do chromosome analyses and such. That’s much rarer and sometimes seen in children. But most adults who develop blood cancers is a spontaneous event that happened from damage from environmental toxins.”
Bone marrow transplants
Shaughnessy explained there are several ways to treat blood cancer, in addition to chemotherapy or radiation. One of the most common treatments is a bone marrow transplant. These are a critical treatment option for blood cancers, particularly for patients with aggressive forms like acute leukemias and high-grade lymphomas.
Bone marrow transplants can offer a chance at long-term disease-free survival, especially for those whose cancers have relapsed or do not respond to standard therapies. There are two main types of bone marrow transplants: autologous and allogeneic.
In an autologous transplant, stem cells are collected from the patient prior to intensive chemotherapy. This approach allows patients to endure high doses of chemotherapy while protecting their bone marrow, as the harvested stem cells can be reinfused afterward to help regenerate healthy blood cells. This method is especially beneficial for treating multiple myeloma and high-grade lymphomas.
Conversely, allogeneic transplants involve using stem cells from a healthy donor. This type is crucial for conditions like acute and chronic leukemias, where cancerous cells fill the bone marrow, rendering autologous transplants ineffective.
“These can be more difficult, higher risk transplants, but can result in cure and long-term disease control for patients who really wouldn’t respond to any other therapy,” Shaughnessy said.
For a successful allogeneic transplant, it is essential to find a matched donor, as the donor and recipient must share similar immune system genes. This matching is determined through DNA typing, and potential donors can be found in national registries like Be the Match or among family members.
Anyone can sign up to be a donor through Be the Match. Donors are crucial because 70% of patients don’t have a fully matched donor in their family. Putting yourself in the system is as easy as a swab of the inside of the cheek or a bit of blood.
“It’s a great thing to be a donor; it’s generally very well tolerated, and we make it as easy on donors as we can,” Shaughnessy said. “The patient can undergo anesthesia, and the bone marrow is harvested through small needles that are inserted into the hip bone. Then, bone marrow can be withdrawn to whatever amount we need for that bone marrow transplant.”
Generally, someone who is called on to be a donor wakes up from anesthesia and might have some local pain for a few days, but they are usually back to full function within days to a few weeks and can go about their daily business.
Donors can be a little anemic for a few days, but bone marrow regenerates and harvests are very well tolerated.
With advancements in matching techniques and transplant procedures, many patients now experience improved outcomes and a better quality of life following treatment.
Shaughnessy said allogenic donors should meet a few criteria.
“They must be under the age of 45, be very healthy and not have any infectious risk complications or autoimmune diseases. The younger and healthier, the better. Believe it or not, a donor can be a different blood type than the recipient, and we check for other viral diseases and things like that.”
Shaughnessy said he would encourage everyone to sign up to be a donor.
“It’s a great thing to do. It’s rare that people get called to be donors, and even if you are called to be a donor, it doesn’t mean you have to do it,” he said. “You’re given the choice. You will undergo an evaluation to make sure the donation process is safe for the donor and that donor is right for the recipient. We need more donors out there. There are people still who cannot find suitable donors and have very serious cancers to treat.”
Immunotherapy
Recent advancements in the treatment of serious blood cancers have significantly improved patient outcomes, particularly using CAR T-cell therapy. The innovative treatment involves extracting a patient’s own T cells, which are crucial components of the immune system.
Using a simple blood draw, millions of T cells are separated from the bloodstream and sent to a laboratory. There, new DNA is introduced into these cells, which enables them to express a chimeric antigen receptor (CAR) on their surface. This modification equips the T cells to specifically target and attack cancer cells.
Once the CAR T-cells are engineered and grown in the lab, they are returned to the treatment center. Before an infusion, patients typically receive a light dose of immunosuppressive chemotherapy to prepare their immune system.
“The CAR T-cells go around the bloodstream of the recipient, attack, multiply, grow and kill those cancer cells,” Shaughnessy said. “It’s like a targeted therapy that goes directly to the cancer cells. It can take some patients from relapsed refractory disease into remission within just a month’s time.”
Approximately 60% to 70% of patients respond to the treatment, and 30% to 50% achieve long-term durable remissions, particularly for lymphoma and acute leukemia.
While CAR T therapy represents a significant leap forward, it is not without risks. As the CAR T-cells engage in battle against cancer, patients may experience flu-like symptoms, such as fevers and muscle aches. In some cases, side effects can be serious enough to require hospitalization.
Shaughnessy added that, because CAR T-cells circulate throughout the body, including the brain, there can be temporary neurological changes. However, most of these effects resolve within seven to 10 days.
Methodist Hospital offers both bone marrow transplants and CAR T treatments, which have greatly expanded physicians’ ability to provide effective care.
New therapies give hope to patients who previously had limited options. It offers the potential for long-term remission or even cures for those with challenging diagnoses. The combination of advanced treatment modalities reflects a significant shift in the management of blood cancers, as it improves outcomes and quality of life for many patients.
“It’s revolutionized what we’re doing in just the last five to 10 years. I have patients who, just a few years ago, I would have been sending home to hospice because I had nothing else to offer their cancer treatment. Now, after CAR T treatment, they are in remission, walking around, leading normal lives, years after their CAR T treatment and they’re probably cured. That’s an amazing thing to see in my own lifetime.”
In addition to treatments, Shaughnessy stressed how important it is to donate blood.
“People can donate blood at almost any age. If they’re healthy and donating blood or red blood cells, it’s good for everybody and not just cancer patients. We have a need for blood and platelet transfusions.
The future of blood cancer research and treatment
Just as there is a need for donors, there is also a need for oncology doctors. Shaughnessy said there is currently a physician shortage. And though it took many years of working with mentors, medical school and training, he said the path he has chosen is worth doing and worth the hard work.
“You get to see these amazing therapies. It’s an honor and a privilege to be on the cusp of such amazing research and treatments. I would never have dreamed we would have CAR T therapy just 10 or 20 years ago. I encourage people to follow their passions, talk to other experienced people and use mentors to work their way through.”
He emphasized that it takes a community of providers to make everything run successfully.
“We could not do what we do here without our nurse practitioners and physician assistants, all of our nurses, pharmacists and social workers. It’s amazing to watch this unfold in front of us.”
To learn more about how you can become a donor, click or tap here.
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