What are the different types and treatments available?

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In September of each year, we celebrate Blood Cancer Awareness Month. There are types of blood cancer, including hematologic cancers, which start in the bone marrow, where blood is produced. Blood cancers occur when abnormal blood cells start to grow and cannot be controlled, and later disrupt the function of normal blood cells, which then fight infection and produce new blood cells.

Blood cancer accounts for eight percent of all new cancer cases diagnosed in India. As there is so much misinformation and lack of awareness around India’s blood cancer population, this requires immediate intervention. Most people don’t know that blood cancer can be managed, and a patient may have a second chance with the help of chemotherapy and other onco treatments.

Categories of blood cancer

  1. Leukemia is a type of blood cancer that starts in the blood and bone marrow, and it happens when our body makes too many abnormal white blood cells and disrupts the bone marrow’s ability to make red blood cells and platelets.
  2. Lymphoma is a cancer of the blood that develops in the lymphatic system from cells called lymphocytes, a type of white blood cell that helps the body fight infections. It is divided into two subcategories, Hodgkin lymphoma and non-Hodgkin lymphoma. Generally, both types perform very well with an overall 5-year survival rate of 60-90%.
  3. Multiple myeloma is a cancer of the blood that starts in plasma cells, a type of white blood cell made in the bone marrow. Multiple myeloma cannot be cured, but the disease can be controlled for a longer period of time, and usually survival is five to seven years or more. Lymphomas and leukemias affect adults and children, but myeloma affects adults.

Common symptoms include

  • Fever with chills
  • Persistent fatigue
  • Weakness
  • Loss of appetite
  • Unexplained weight loss
  • Night sweats
  • Bone / joint pain
  • Shortness of breath
  • Frequent infections
  • Swollen lymph nodes in the neck, armpits or groin.

Treatment of blood cancers

Treatment depends on several factors. The first is the type of cancer and how quickly the cancer metastasizes, the second is where the cancer has spread and other factors.

Common treatments for blood cancer

  • Chemotherapy: Chemotherapy uses anti-cancer drugs to interfere with and stop the growth of cancer cells in the body, and this treatment sometimes involves giving several drugs together in a set regimen.
  • Bone marrow transplantation (GMO): A stem cell transplant infuses healthy hematopoietic stem cells into the body. A bone marrow transplant can be autologous (its own stem cells) or an allogeneic transplant (either a matched sibling or an unrelated donor). Bone marrow transplantation has now become the only treatment option for blood cancers in the event of a relapse. A successful transplant may give them a second chance at life, depending on the condition of the disease and the type of donor
  • CAR T cell therapy: new modality to come in the field of treatment of blood cancer in the context of relapses and refractories. Basically, patients’ own T cells are genetically modified in the lab to kill cancer cells. The advantage of CAR T cell therapy is that the side effects of high dose chemotherapy and transplant complications can be avoided. Cons being very expensive (cost around Rs 3-4 crores)
  • Radiotherapy: It destroys cancer cells or relieves pain or discomfort.

Although the prognosis for leukemia does not seem as good as that of its counterparts described above, a certain type of leukemia has a very good prognosis with around 80-90% survival with proper treatment. APML (acute promyelocytic leukemia) is one of these types.

In PMLA, abnormal immature neutrophils called promyelocytes accumulate in the bone marrow and these immature cells in the marrow inhibit the production of normal cells, resulting in a decrease in the number of blood cells circulating in the body.

APML is mostly associated with the exchange (translocation) of chromosomes 15 and 17. According to data, 6 cases per 10 million people suffer from APML. One of the most common symptoms of PMLA is bleeding because it reduces the number of platelets and clotting factor deficiencies. Bleeding can be life threatening. The diagnosis of PMLA involves tests of the blood and bone marrow. Special tests like FISH and RT PCR are also performed.

Treatment for APL is usually urgent and is managed with supportive measures such as transfusion of platelets and blood clotting factors. Drugs like ATRA (all-trans-retinoic acid) and arsenic trioxide and chemotherapy are used. Early diagnosis and prompt treatment of blood cancers improves outcomes and better survival.

(With contributions from Dr Ramnath Shenoy K, Assistant Professor, Medical Oncology, KMC, Manipal)


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