Life-Saving New Options for Blood Cancer Patients
Once-fatal diseases are often now treatable and sometimes curable—thanks to scientific breakthroughs in treatments performed at Saint Barnabas Medical Center.
Cancer can form almost anywhere in the body, including in the blood. Known as hematologic cancer, or blood cancer more simply, these diseases disrupt the production and function of blood cells. Their names are well-known—and scary: leukemia, lymphoma and myeloma. But recent advances have rendered many of these once-fatal cancers not only treatable, but in many cases curable.
I. Robert Grossman, M.D.
“When I was in medical school, most patients died from myeloma,” says I. Robert Grossman, M.D., a hematologic oncologist at Saint Barnabas Medical Center. Thanks to these new treatments, “survival is 10 to 15 years and even longer, not just a few months to a year.”
The American Society of Hematology (ASH) says that most types of blood cancer start in bone marrow, where stem cells develop into red blood cells, white blood cells or platelets. Cancerous blood cells prevent blood from performing many of its functions, including fighting off infections or preventing serious bleeding, the ASH says.
- Leukemia, a rapid production of abnormal white blood cells that are not able to fight infection and impair the production of red blood cells and platelets.
- Lymphoma, which affects lymphocytes, a type of white blood cell that fights infection. Cancerous lymphocytes collect in the lymph nodes and other tissues and compromise the immune system.
- Myeloma, a cancer of the plasma cells that create antibodies in the body to fight disease. Myeloma, like the other blood cancers, weakens the body’s immune system.
There are dozens of subtypes of each of these diseases, but even when put together, they are less common than other forms of cancer. “Breast cancer has 260,000 new cases a year in the U.S., lung cancer 230,000 and colon cancer 150,000,” Dr. Grossman says. “In contrast, there are just 80,000 of all the various types of lymphomas; 30,000 myelomas, 20,000 acute myelogenous leukemias and fewer still of many other subtypes.”
Some of these cancers are genetic in nature, while others can be caused by immunosuppressive diseases like HIV/AIDS, being on immunosuppressant medications after organ transplants or being exposed to environmental chemicals, like in the weed killer Roundup. “But most are sporadic. They just happen,” Dr. Grossman says, for unknown reasons.
The first line of treatment is chemotherapy, which is still very effective for many forms of blood cancer. “Chemo still has its role, and in certain cancers chemo will be curative,” he says. For example, acute lymphoblastic leukemia and Hodgkin lymphoma were “uniformly fatal” until the development of chemotherapy in the 1950-1960s; “now they are highly curable,” he says. But if blood cancers recurred after chemotherapy, then little could be done for those patients.
In the last decade or two, though, oncologists have switched their attention from chemotherapy to what’s known as targeted therapy. As more is known about the genetic makeup of these cancers, oncologists have found what “turned the cancer on or off,” Dr. Grossman says, and created drugs that target those specific genes. “It targets what’s different in cancer and kills that. It’s like using a smart bomb versus a dumb bomb,” he says.
The ASH reports that these advances “offer vast clinical promise to impact a wide array of diseases, including acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), Hodgkin and non-Hodgkin lymphoma and myeloma, as well as non-malignant hematologic disorders such as sickle cell anemia and other inherited hematologic or metabolic diseases.”
One type of targeted therapy, immunotherapy, enhances the body’s own immune system to fight off the cancer. For instance, the patient’s T cells, which are strong disease-fighting immune cells, can be taken out of the body and “reprogrammed” to better attach to and attack certain cancer cells. These re-engineered T cells are then reintroduced to the patient and begin their assault on the disease. Studies have shown this approach can potentially cure certain types of blood cancer, even those that have failed all other types of therapy.
Indeed, the results have been dramatic. Patients with multiple myeloma used to live just one to two years; now they live 20 or more, Dr. Grossman says. Chronic myeloid leukemia (CML) patients also had one- to two-year survival rates; now, 90 percent of patients can have a normal life span, thanks to a drug that targets one specific genetic defect. Chronic lymphocytic leukemia (CLL) is usually a more slowly growing disease, but some forms are highly aggressive and resistant to chemotherapy. New therapies have shown significant improvement in response and survival in these patients with far fewer side effects and better quality of life. “Even with the worst cases, we have options that weren’t there before,” Dr. Grossman says.
These new options are coming fast and furious, he says, across all areas of hematologic cancer. Where is it all headed? “As the science gets better, we can break down cancers into different groups that benefit from different treatments, and then we can tailor therapy more appropriately for a more personalized approach,” he predicts. “It’s a pretty remarkable field now, offering new hope to our patients.”