New advances enhance blood cancer treatment options

Receiving a cancer diagnosis is an experience that stirs a complex range of emotions. Dr Lim Zi Yi, medical director of the Centre for Clinical Haematology, has observed a spectrum of reactions, from shock and denial to calm acceptance. 

However, for those grappling with a blood cancer diagnosis, there is hope. “In the last two decades, particularly within the last five to 10 years, there has been significant progress in treatment options for patients with lymphoma and other blood cancers,” said Dr Lim, who is also president of the Bone Marrow Donor Programme (BMDP) in Singapore.

According to Dr Lim, recent advances in understanding the biology of such conditions have paved the way for treatments “that are far more effective”. “Moreover, we now have a broader range of tools to combat cancer across multiple stages, with side effects and toxicities becoming increasingly manageable,” he added. 

RISK FACTORS AND DETECTION

According to Dr Lim, blood cancers like myeloma, leukaemia and lymphoma are becoming more prevalent globally. However, the precise factors driving this trend remain unclear.

One such factor, he posited, is increasing life expectancy. Many blood cancers, such as leukaemia, tend to manifest more frequently among individuals in their 50s and 60s. 

Dr Lim suggests taking a proactive approach to safeguarding against blood cancers – for instance, self-examination can aid in earlier detection of blood conditions such as lymphoma. “The condition is typically detected when a patient discovers an unusual and persistent swelling of the lymph glands in the neck, groin or armpit,” he said. 

Other lymphoma-associated red flags include unexplained significant weight loss, drenching night sweats, itching and extreme lethargy. “While these symptoms may not definitively point to the disease, they merit further investigation,” Dr Lim underscored.

A BROADER RANGE OF TREATMENT OPTIONS

When a patient receives a lymphoma diagnosis, the next step is for the attending specialist to present options and formulate a treatment plan. Treatment options include chemotherapy, which uses cytotoxic drugs to disrupt the action of rapidly dividing cancer cells; monoclonal antibody drugs that target cancer cells and spare healthy cells; as well as immunotherapy that activates the immune system to combat cancer. 

At present, most patients will receive a combination of these options in the initial treatment of lymphoma. Typically administered to patients diagnosed with diffuse large B-cell lymphoma, one of the more aggressive lymphoma sub-types, this regimen has yielded significant success, with nearly 70 per cent of individuals achieving cancer remission, said Dr Lim. 

However, lymphoma remains a challenging condition to treat in a smaller group of patients who do not respond favourably to this treatment plan. Reflecting the advancements made in the treatment domain, Dr Lim shared that a new modality – chimeric antigen receptor (CAR) T-cell therapy – is now available for such patients. 

CAR T-cell therapy is a form of immune therapy that entails the harvesting of the patient’s T-cells (cells normally engaged in fighting cancer). These harvested T-cells are subsequently genetically modified in a laboratory, which enables them to express receptors tailored to kill cancer cells.  

Explaining why this is necessary, Dr Lim shared that for patients undergoing therapy, their T-cells sometimes encounter difficulties identifying cancer cells within the body, resulting in their reduced effectiveness.  

Post-modification, the manufactured CAR T-cells are infused back into the patient’s body. Elaborated Dr Lim: “Upon recognition of the cancer cells, the CAR T-cells initiate a targeted and often vigorous immune response. This treatment modality typically succeeds in eliminating underlying blood cancer cells in a substantial proportion of cases.”

However, Dr Lim cautioned that not all cancers respond to CAR T-cell therapy, and that the treatment is only suitable for certain patients. “It is solely administered to patients with specific blood cancers, and who have not responded to other treatments. Moreover, significant side effects could also manifest in some patients. These include neurological toxicity – which affects the brain and causes confusion – and cytokine release syndrome, which can cause patients to become quite sick due to the chemicals released during the immune response of cancer cells.”

As such, it’s crucial to consult your specialist to determine if you are a suitable candidate for CAR T-cell therapy, he advised. 

COMBATING CANCER IS A COLLECTIVE EFFORT

The fight against lymphoma and other blood cancers often requires the expertise of a multidisciplinary team. “Led by haematologists, a team of specialists work in concert to manage the treatment’s potential side effects and complications,” said Dr Lim. 

Additionally, allied health professionals such as nurses and dietitians ensure a well-rounded approach to patient care.

Apart from the medical team, a robust support system comprising family members or close friends can significantly impact patient outcomes. “Coping with cancer can be mentally and physically exhausting. Having a strong support network is invaluable as it assures patients that they are not on this journey alone,” said Dr Lim. 

For additional assistance, Dr Lim directs local patients to organisations such as the Leukaemia and Lymphoma Foundation, which lends access to support networks and resources. 

He also often reminds patients not to let a cancer diagnosis dominate their lives. “While undergoing treatment, they should continue engaging in activities they enjoy, whether it’s painting, cooking or looking after their children. Treatment options for lymphoma have advanced significantly in the last 10 years, providing ample reason for optimism regarding health outcomes.” 

If you or a loved one has lymphoma or a blood cancer, speak to your doctor to find out more about treatment options.