By Sewa S. Legha, MD
Cancer can arise from any of the tissues of the human body, so the blood forming tissues (Bone marrow and Lymph glands) are no exception. Cancer that begins in the marrow is commonly called Leukemia and these cancerous cells circulate in the blood and can be easily detected by looking at the blood under a microscope. Cancer arising from the lymph glands is commonly called a Lymphoma. Another cancer arising in the bone marrow is called a Multiple myeloma but this one remains inside the bones which are often eaten up by the cancerous cells and tend to break easily. There are many subtypes of Leukemia and Lymphomas some of which are acute and aggressive; others are more indolent and run a chronic course over several years.
Cancers of the blood are commonly called Hematologic cancers as opposed to rest of the cancers which are called Solid tumors. Whereas the solid tumors constitute 90% of all cancers Blood cancers account for about 10%. This translates to about 150,000 cases of blood cancers diagnosed in the US each year. Among all human cancers, Blood cancers tend to be generally more curable, with a few exceptions. No age is exempt from developing blood cancer. In fact among the Blood cancers, Leukemia is one of the more common cancers among the pediatric age group. Fortunately children respond to cancer treatments with much better results such that childhood leukemia is cured in more than 80% of cases.
Signs and Symptoms:
Patients with Blood cancer, especially those who have Leukemia, often present with impaired blood formation resulting in Anemia(low Hemoglobin), low or high white blood count and low platelet count. Since each of these cell types performs important physiologic functions in our body, patients may experience increasing fatigue or tiredness due to anemia or fever due to infections resulting from impaired production of normal white cells. Bleeding and easy bruising may be another manifestation due to low platelet counts. Patients with Lymphoma often present with fever or night sweats. Sometimes they may feel their enlarged? lymph nodes especially in the neck area or in the groins. Patients with Multiple myeloma typically present with bone pain, often arising from their spine or sometimes develop a bone fracture from relatively minor trauma. An unexplained weight loss, poor appetite or persistent fever can be the presenting features of any cancer, including blood cancer.
Treatment of Blood Cancer:
As opposed to its critical role in the treatment of the Solid tumors, surgery plays no role in the treatment of blood cancers. Similarly Radiation therapy has a limited role to play for treatment of blood cancers especially in Leukemia and multiple myeloma. Lymphomas do respond well to Radiation therapy although chemotherapy is the mainstay of treatment for nearly all Blood cancers. The types of chemotherapy drugs used is quite varied depending on the type of blood cancer. Similarly the success of chemotherapy in controlling blood cancer varies with each type of blood cancer. Overall cure rates with first line chemotherapy range from 40% to 90%, averaging at about 65%. Patients who relapse or fail to respond well to treatment with first line chemotherapy are much harder to treat although there is some limited success with second line chemotherapy. For a majority of such patients the only chance of controlling their cancer is to use High dose chemotherapy given with the aid of Bone marrow transplantation. This procedure is technically demanding and has high costs associated with the complex and prolonged management of such patients.
Blood Stem Cell transplantation/ Bone Marrow transplantation:
The mother cells from which our body makes blood are called Stem cells or Hematopoietic Stem cells. These cells typically reside in the Bone marrow from where they can be taken out and used as a component of the procedure commonly called Bone Marrow Transplantation (BMT). In this procedure massive doses of chemotherapy are used to first eradicate the Cancer cells after which the stem cells are given back to the patient in order to rescue or re-establish the normal blood formation in the bone marrow. The source of stem cells can be the patient who has the cancer provided his/her bone marrow is healthy?.this procedure is called Autologous Stem cell transplantation. An alternative source of stem cells can be a healthy donor where the procedure is called Allogeneic Stem cell transplantation (Allo-Tranplant). The Donor for the Allo-tranplant can be a related family member or an unrelated volunteer donor provided his body tissue type matches well with the recipient?s tissue type.
The procedure of BMT has been perfected over the past 50 years and has a high cure rate of about 50%. But it is also associated with considerable toxicity or risks primarily from a reaction called Graft versus Host disease (GVHD) which can be fatal. The GVHD is caused by an immunological reaction between the donor cells (graft) and the body organs of the recipient (Host). The best way to avoid the GVHD is to obtain a good tissue match between the donor and the recipient?s body cells (matched HLA types). In order to avoid rejection of the stem cell graft by the host, immunosuppression is carried out with the help of total body irradiation (TBI) before the Stem cell transplant is given to the patient as well as the use of immunosuppressive drugs give after the transplant. It takes nearly 3 months to successfully carry out the Allogeneic stem cell transplants in patients who have blood cancer which is beyond any curative treatment with the standard chemotherapy. A National Marrow Donor Program (NMDP) has been set up to facilitate an adequate donor pool to meet the demands of patients with Blood cancer.
The Indian American Cancer Network (IACAN) is committed to provide proper health education and to promote cancer awareness and prevention through educational seminars in the community. It also provides various services to both patients and care givers through its network of liaisons- Provide cancer information, assist in navigating available medical care, access and pool available resources, counsel on support services, address culture-specific grief, end of life/loss and bereavement issues.
For more information visit www.iacannetwork.org or call 713-370-3489.?
To learn more about Blood Cancer please attend the Educational Outreach event on February 24 at VPSS Haveli, 11715 W Belfort Village Dr. Houston, TX 77031. Time: 1-3:30pm.
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