Blood Cancer Awareness Month: Educate, Detect, Support!

Navigating blood cancer can be overwhelming. But having a solid support system can make all the difference. Whether it’s family, friends, healthcare professionals, or fellow patients, these connections provide strength, comfort, and hope during the most challenging times.

Therefore, this September, we’re dedicating our Blog to not only raising awareness, but also educating around various blood cancers and disorders and guiding to encouraging patient stories.

What is Blood Cancer

Blood cancer, also known as hematologic cancer, is a broad term covering a variety of cancer types that impact the production and function of blood cells. In healthy people, blood cells are created in the bone marrow, a spongy substance found in the middle of bones. Blood cancer develops when abnormal cells proliferate uncontrollably in the bone marrow, disrupting the normal the production and function of blood cells.

There are three types of blood cells: red blood cells, white blood cells, and platelets. Red blood cells transport oxygen throughout the body, while white blood cells combat infections and platelets aid in blood clotting. Blood cancers may harm any of these types of blood cells.

The Broad Variety of Blood Cancer Types

The different types of blood cancer include:

1. Leukemia: This is a cancer of the white blood cells, which affects their ability to fight infections. Leukemia can be acute or chronic, depending on the speed at which the cancer develops.
2. Lymphoma is a cancer of the lymphatic system, which is responsible for fighting infections and filtering toxins from the body. Lymphoma can be Hodgkin’s or non-Hodgkin’s lymphoma, depending on the type of cell affected.
3. Multiple myeloma is a cancer of the plasma cells, which are a type of white blood cell that produce antibodies. Multiple myeloma affects the body’s ability to produce healthy antibodies and combat infections.
4. Myelodysplastic syndromes are various disorders that affect the bone marrow’s ability to produce healthy blood cells. It can lead to a shortage of one or more types of blood cells.
5. Myeloproliferative neoplasms cause an overproduction of blood cells in the bone marrow, leading to an imbalance in the different types of blood cells.

Science in Progress — The History of Blood Cancer

1845

Rudolf Virchow, a German pathologist, coined the term “leukemia”, after observing a high amount of white blood cells in a patient’s blood sample.

1863

French physician Armand Trousseau discovered chronic myeloid leukemia (CML), a slow-growing type of blood cancer.

1951

American physician William Dameshek proposed the concept of “myeloproliferative disorders”, broadening the understanding of blood cancers.

1960

The Philadelphia chromosome, a genetic abnormality linked to chronic myeloid leukemia, was discovered by Peter Nowell and David Hungerford.

1973

Janet Rowley confirmed that the Philadelphia chromosome resulted from a genetic translocation between chromosomes 9 and 22 and creates a mutated gene which drives white blood cells into uncontrolled growth.

1977

The first successful bone marrow transplant was performed by Dr. E. Donnall Thomas, paving the way for a new treatment for blood cancers.

1986

Interferon-alpha, a drug used to treat certain blood cancers, was approved by the FDA.

2001

The targeted cancer drug imatinib (Gleevec) was approved by the FDA, addressing the mutated gene on the Philadelphia chromosome and revolutionizing the treatment of chronic myeloid leukemia.

2017

The FDA approved the first CAR-T cell therapy, a groundbreaking immunotherapy treatment for certain types of blood cancer.

Recognizing possible signs of blood cancer

Possible symptoms of blood cancer include

• Tiredness, fatigue and reduced performance
• Persistent fever
• Night sweats
• Unwanted rapid weight loss

If the leukemia progresses and more and more healthy blood components are displaced, further symptoms may occur, such as paleness, shortness of breath, dizziness or palpitations. In addition, a tendency to bleed, bruising and increased susceptibility to infections can occur.

If any of these symptoms occur, a doctor should always be consulted to clarify the cause.

Risk factors for blood cancer

In most cases, no clear cause of blood cancer can be determined. It is assumed to be a random change in the genetic material of a single blood cell that leads to the uncontrolled proliferation of cancer cells. However, a number of factors are known that can increase the risk of developing blood cancer. Possible risk factors for blood cancer are

Hereditary predisposition: Blood cancer is not directly inherited, but a hereditary predisposition is observed. The risk of developing blood cancer is therefore increased if there is a family history of malignant diseases. In addition, congenital genetic changes, such as trisomy 21, can increase the risk of certain forms of blood cancer.

Radiation exposure: Radioactive radiation can increase the risk of acute leukemia in particular. The risk of developing blood cancer increases with frequent exposure to radiation.

Chemical substances: There are certain chemical substances that are known to promote the development of blood cancer. These include solvents used in industry such as benzene. Insecticides and pesticides are also suspected of contributing to the risk of blood cancer.

Medicines: Some medication used to treat cancer can increase the risk of blood cancer in the long term. A risk-benefit analysis is therefore always necessary when using them.

Smoking: Smoking is one of the avoidable risk factors for blood cancer. Tobacco smoke contains many carcinogenic substances, including benzene. Experts estimate that around 10 % of blood cancers are attributable to cigarette smoke.

Age: Age is also one of the risk factors for AML, CLL and CML. The risk of developing the disease increases with age.

Treatment of Blood Cancer

There are a range of different treatments for blood cancer. The recommended treatment will depend on the type of blood cancer, the general health and the preferences of the patient.

Watch and wait

Some people with blood cancer don’t need treatment straight away, and some never need it. For a slow-growing blood cancer, the watch and wait strategy may be recommended.

Watch and wait is offered when the doctor believes there’s no added benefit to starting treatment straight away. If the cancer is not causing any troublesome symptoms, watch and wait is a safe approach that avoids the side effects of cancer treatments. Patients will be monitored with regular check-ups and blood tests, and only start treatment if and when needed.

Chemotherapy

Chemotherapy is the use of chemicals that kill cancer cells.

Chemotherapeutic drugs are often administered straight into a vein. The medicines can go through the bloodstream to attack cancer cells. Many people receive chemotherapy as outpatients, meaning they travel to the hospital for treatment and then return home.

Chemotherapy can also be administered as pills, either as part of a course of treatment or as a longer-term treatment.

Chemotherapy is often administered in cycles. A cycle consists of chemotherapy followed by a time of rest without treatment. The number of cycles and the specifics of the treatment will be determined by the type of blood cancer and the medicines used.

While chemotherapy can destroy cancer cells, it also harms healthy, rapidly growing cells in the body. This is what causes chemotherapy side effects such skin and mucous membrane irritation, hair loss, and bone marrow damage.

Stem cell transplant

All blood cells originate as stem cells in the bone marrow. Blood cancer occurs when something goes wrong during the growth of blood cells and they become cancerous.

A stem cell transplant can be used to treat some blood cancers by killing the faulty stem cells that are making cancerous blood cells and replacing them with new, healthy stem cells capable of producing healthy blood cells. This entails first undergoing large doses of chemotherapy to destroy the patient´s current stem cells, followed by a transplant to rebuild the bone marrow with healthy stem cells.

There are two approaches to stem cell transplantation. In autologous stem cell transplantation, the patient’s own hematopoietic stem cells are removed from the bone marrow or blood and returned to the patient following high-dose chemotherapy, which enables the recovery of hematopoiesis and bone marrow function. Myeloma and lymphoma are currently the domain of this autologous blood stem cell transplantation.

Allogeneic blood stem cell transplantation is to be distinguished from this. In most cases of leukemia, stem cell transplantation usually needs to be allogeneic. This means, someone else’s stem cells (a donor’s) are used for the transplant (read more in our Blog Cord Blood Banking | TheKnowHow).

The stem cells are given into the patient´s vein, in a similar way to having chemotherapy or a blood transfusion.

CAR-T-Cell-Therapy

In CAR-T cell therapy, immune cells are genetically modified so that they recognize and fight cancer cells. The patient’s own immune cells are removed, processed in the laboratory and reintroduced via an infusion — without the need for a foreign donation.

The blood consists of thousands of different cells. A special group of white blood cells makes up part of this: the T cells. They are responsible for the body’s immune defense and find, bind and destroy diseased or defective cells. The problem with cancer patients: The T cells are practically blind to cancer cells and do not recognize them as a threat. With the help of genetic engineering treatment, however, the T cells can be converted into Chimeric Antigen Receptor T cells, or CAR T cells for short, in the laboratory. These synthetic T cells can identify the diseased cells with their antigen-specific receptors. A breakthrough in cancer therapy.

CAR-T cell therapy is currently only intended for patients for whom all other treatment methods have been unsuccessful. Before the patient can receive the removed and genetically modified cells again, they receive chemotherapy. This prepares the body to receive the CAR-T cells so that they can work and multiply unhindered.

CAR-T therapy is based on an autologous transplant. This means that the donor of the cells is also their recipient. Blood is first taken from the patient via the veins, which flows into a type of dialysis machine where T cells are filtered out by means of a blood purification process known as leukapheresis before the blood is returned to the body.

The cells obtained in this way are frozen and sent to specialized laboratories. There they are genetically engineered so that the T cells produce a protein that can recognize and bind cancer cells. From this stage, they are referred to as CAR T cells. This process takes up to 27 days.

Shortly before the CAR-T cells are transplanted, the patient receives chemotherapy. This destroys as many T cells in the blood as possible, making it easier for the CAR T cells to spread. The cells prepared in the laboratory are then infused into the bloodstream. Their task is to multiply, track down the cancer cells and eliminate them.

Currently, the CAR-T cell therapies currently approved are for certain B cell lymphomas and for certain acute lymphoblastic B cell leukemias. Other CAR T cell therapies are currently under review, for example for use in relapsed or refractory multiple myeloma. However, they have not yet been approved and can only be used in trials.

Side effects can occur after the infusion of CAR-T cells: These include inflammatory reactions, nerve damage, cardiovascular damage or cytokine release syndrome (CRS), which can lead to life-threatening fever, chills and breathing difficulties. As the therapy is still relatively new, there have not yet been any studies on possible long-term effects.

CAR-T cell therapy has shown a very good response in the majority of patients treated.However, it is still unclear whether long-term disease control or even cures can be achieved.

Checkpoint inhibitors

These drugs are still in the study phase for blood cancers. They also trigger an immune reaction in the body against the leukemia cells and are being tested for various forms of cancer. Treatment with them is therefore only possible in clinical trials.

Treatment of Leukemia — For Adults

Treatment of acute myeloid leukemia (AML)

Rapid treatment is important: In acute myeloid leukemia (AML), leukemia cells spread rapidly in the bone marrow, blood and throughout the body within a few weeks. Fewer and fewer normal blood cells are formed in the bone marrow and the affected organs are impaired in their function. As a result, serious symptoms develop within a short period of time. Patients are at acute risk.

The aim of treatment is to cure the disease if possible: the therapy should completely destroy the leukemia cells and restore normal blood formation.

For most patients, treatment centers on intensive chemotherapy. If patients have certain genetic changes in their AML cells, doctors may use targeted drugs in addition to chemotherapy. For some patients, high-dose chemotherapy followed by a blood stem cell transplant is also an option as part of the initial treatment.

AML therapy takes place in different phases:

• Pre-therapy is intended to initiate induction therapy as gently as possible. It is not necessary for all patients.
• Induction therapy is intended to suppress the leukemia cells as quickly as possible.
• Consolidation and maintenance therapy should kill any remaining malignant blood cells in the body and ensure the long-term success of the therapy.

There is no standard treatment: despite progress in AML therapy, there is currently no therapy that is equally suitable for all patients. The type of treatment, the therapy regimen, the dosage and the course of therapy can differ from patient to patient. The AML subtype of the patient and the doctors’ assessment of the patient’s risk of relapse play a major role here.

Treatment of acute lymphoblastic leukemia (ALL)

Rapid treatment is important: In acute lymphoblastic leukemia (also known as acute lymphoblastic leukemia, ALL), symptoms usually develop rapidly within a few weeks. If left untreated, the disease would lead to death. Doctors must therefore start treatment as soon as possible after the diagnosis of ALL.

The aim of treatment is to cure most patients with ALL: this means that the therapy permanently eliminates the leukemia cells and restores normal blood formation.

Experts consider ALL to be cured if no relapse has occurred five years after the start of treatment.

Intensive chemotherapy is at the heart of ALL treatment. The treatment lasts around two and a half years. At the beginning of treatment, patients must remain in hospital. As the treatment progresses, they can also be treated on an outpatient basis if necessary. If there is a high risk of relapse, a blood stem cell transplant may also be part of the treatment.

ALL therapy takes place in different phases:

- Pre-phase therapy is intended to initiate the destruction of the leukemia cells as gently as possible.

- Induction therapy aims to suppress the leukemia cells as quickly as possible and restore healthy hematopoiesis.

- Consolidation therapy is intended to kill any remaining malignant blood cells in the body and prevent a relapse.

- Maintenance chemotherapy is given to all patients who do not receive a stem cell transplant.

During treatment, the doctors regularly check the blood values: this enables them to recognize in good time if blood formation or organ function is impaired. At certain times, they also carry out a bone marrow examination to check the success of the treatment.

Targeted treatment of the brain is important: leukemia cells can already be present anywhere in the body at the time of diagnosis, including in the brain and spinal cord. This is why doctors inject chemotherapeutic agents directly into the patient’s cerebrospinal fluid at regular intervals as a preventative measure and irradiate the brain and meninges.

To date, there is no “standard therapy”. According to the leukemia experts, doctors should preferably treat their patients with ALL within the framework of clinical trials. Special therapy recommendations are available for patients over the age of 55 and with concomitant diseases. The reason for this is that the usual intensive chemotherapy can be too stressful for these patients.

The side effects of intensive chemotherapy can be severe without adequate supportive treatment. Measures that alleviate or avoid side effects are therefore an important part of treatment for anyone affected by acute lymphoblastic leukemia.

Treatment of chronic myeloid leukemia (CML)

Targeted drugs that are precisely tailored to the cause of chronic myeloid leukemia (CML) have significantly improved the prognosis of affected patients: they have almost the same life expectancy as the healthy population.

The drugs target a genetic change that is present in the majority of CML patients: the so-called Philadelphia chromosome. Chronic myeloid leukemia, which does not have this alteration, is a biologically and clinically different disease and is not the subject of this section.

Targeted therapy is intended to reduce CML as far as possible and prevent the disease from progressing. Doctors cannot use it to cure CML. But they can ensure that it becomes a chronic disease with which those affected can usually live a normal everyday life with a good quality of life.

If the disease progresses despite this, a blood stem cell transplant or chemotherapy may also be considered.

Doctors monitor the success of the treatment with the help of regular follow-up checks. To do this, they regularly examine blood and/or bone marrow samples. The better a patient’s CML responds to treatment, the better the prognosis of being able to control the disease in the long term.

Many CML patients are treated in therapy trials. Together with the doctor treating them, patients can decide which trial is suitable for them. Various criteria such as disease characteristics, disease phase, previous treatment, age and risk factors play a role.

Treatment of chronic lymphocytic leukemia (CLL)

If chronic lymphocytic leukemia (CLL) does not yet cause any symptoms, it is usually sufficient to examine the patient regularly and check the blood values.

If symptoms occur due to CLL or the disease is already at an advanced stage, various targeted drugs, antibodies and chemotherapy may be considered.

A permanent cure for CLL is not yet possible. However, the possible therapies almost always succeed in reducing CLL and improving disease-related symptoms.

Disease activity determines the start of therapy

Doctors can recognize that CLL is “active” and therefore in need of treatment by various factors, for example by the fact that

- the blood values deteriorate rapidly — especially if the number of red blood cells and platelets falls sharply.

- the spleen and/or lymph nodes are very large.

- certain white blood cells (lymphocytes) multiply rapidly.

- those affected have general symptoms: unexplained fever above 38 degrees, heavy night sweats and severe, unintentional weight loss.

It only takes one of these signs of disease activity for doctors to start treating a patient.

When to wait, when to treat?

Patients with an early stage of chronic lymphocytic leukemia (CLL) usually have no symptoms due to CLL. The disease progresses slowly and those affected have a life expectancy comparable to that of the healthy population. They do not require any specific treatment. Instead, doctors monitor the disease regularly. Experts refer to this strategy as “watch and wait”. Clinical studies have shown that CLL patients do not live longer if they receive treatment before they experience symptoms of the disease. Patients are therefore spared a stressful therapy with “watch and wait”. This allows them to maintain their quality of life during this phase of the disease without having to worry about being at a disadvantage.

For patients with an intermediate stage of CLL, doctors make their approach dependent on the disease activity: Depending on the patient’s individual situation, they either wait or initiate treatment.

Patients with an advanced stage of CLL usually already have symptoms caused by the disease and require treatment.

Most important:

Experts recommend that patients with blood cancer should seek treatment at a center that has extensive experience in the diagnosis and treatment of this disease.

Treatment for children have special requirements and my differ from the treatment strategies for adults.

Information from the Internet, such as our blog, can provide you with an overview. However, it is not a suitable substitute for advice from a doctor. Talk to your doctor!

Or contact TheKnowHow if you are looking for an expert for an independent second opinion.