Understanding blood cancers, and how treatment advances offer hope

Blood cancer affects people across all ages and genders. However, awareness of the disease remains low due to its disparate nature. 

“Many people think that there’s only one type of blood cancer; they are more aware of other common cancers such as colorectal and breast cancer,” said Dr Colin Phipps, senior consultant, haematology, at Parkway Cancer Centre Singapore.

In reality, there are different types of blood cancers, many of which can be life-threatening if left untreated. In Singapore, blood cancers are among the 10 most frequent cancers in men and women, based on data from the Singapore Cancer Registry Annual Report 2019. And according to the International Agency for Research on Cancer’s Cancer Today, approximately 40 per cent of global blood cancer cases in 2020 were diagnosed in Asia.

BLOOD CANCERS, EXPLAINED

Blood cells are essential for survival. They transport oxygen and nutrients around the body, help fight infection and control bleeding, among other important functions. When a person has blood cancer, the normal production and functioning of blood cells are disrupted.

Most blood cancers start in the bone marrow; the most common types are the leukaemias, lymphomas and multiple myelomas. While some types are slow-growing, Dr Phipps shared that certain aggressive blood cancers, such as acute leukaemias, can pose an immediate threat to life, with the patient’s condition deteriorating rapidly within months.

According to Dr Phipps, there are only a few known risk factors that increase the susceptibility of a person to blood cancer – these include occupational exposure to certain chemicals and pre-existing chronic conditions such as rheumatoid arthritis. Patients who require long-term immunosuppressive medications may also be more vulnerable. However, for the population at large, no clear risk factors can be identified.

SPOT THE RED FLAGS

Common symptoms of blood cancer include unexplained prolonged fever, an increased incidence of bleeding (around the gums, for instance), fatigue and unintentional weight loss.

Some patients may experience “drenching” night sweats, “the sort that leaves the whole pillow wet and requires a change of clothes”, said Dr Phipps.

As blood cancer symptoms resemble those of other conditions, some cases may not be easily detected. Dr Phipps said it is not uncommon for the more slow-growing blood cancers, such as chronic leukaemia, to be picked up only through abnormal blood count results during routine health screenings.

POST-DIAGNOSIS: A LOOK AT TREATMENT OPTIONS

“There are many treatments available, even for the most aggressive forms of blood cancer, or when patients relapse. The goal of acute leukaemia treatment is to cure the patient,” Dr Phipps said. 

For common blood cancers like acute lymphoblastic leukaemia (ALL) and diffuse large B-cell lymphoma (DLBCL), chemotherapy is the backbone of treatment, Dr Phipps said. Other treatment options include radiation, targeted therapy and stem cell transplantation.

However, even with successful treatment, the cancer may come back in some patients. For example, the relapse rate for ALL in adults is around 30 to 40 per cent, while that of DLBCL is around 40 per cent, Dr Phipps shared. 

“Like all cancers, a relapse comes with some level of resistance to chemotherapy. We can try to use different types of chemotherapy but the success rate for patients who relapse is lower than that in patients who are newly diagnosed and treated for the first time,” he said.

REPROGRAMMING IMMUNE CELLS TO FIGHT CANCER

There have been promising developments in blood cancer treatments for patients who have relapsed, Dr Phipps shared. An example of this is chimeric antigen receptor (CAR) T-cell therapy, which is approved and available in Singapore, a first in Southeast Asia. 

The novel treatment involves extracting the patient’s own immune cells – called T-cells – and reprogramming them in a laboratory to enable them to recognise and fight cancer cells expressing a protein called CD-19. The genetically modified cells are then infused into the patient.

CAR T-cell therapy can be used to treat patients with multiple relapsed DLBCL and young ALL patients who have relapsed, Dr Phipps shared. 

The treatment is not without potential side effects. According to Dr Phipps, these include cytokine release syndrome – that may result in symptoms such as high fever, nausea and vomiting – and difficulty in breathing. Another potential side effect is neurotoxicity, which affects the central nervous system of the patient. 

For relapsed ALL and DLBCL patients, CAR T-cell therapy can help to support the management of the disease in the long run. Dr Phipps pointed out that the first patient treated using CAR T-cell therapy in clinical trials has been in remission for 12 years.

Said Dr Phipps: “CAR T-cells do not die. The presence of these modified T-cells can still be detected in the blood years later, so they act like a ‘security guard’. Indeed, CAR T-cell therapy has made meaningful improvements in the quality of life for some blood cancer patients.”
  
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