Treatment:
In the 21st century, the treatment of blood cancer has undergone a sea change. No longer is it a universally lethal disease that cannot be treated.
Today, with the medical advances we possess, blood cancers can be treated and most can be cured, while the slow growing, indolent cancers can be controlled.
Modern treatment allows us to customize treatment for each patient, ensuring they receive the most effective therapy, with minimal side-effects, that allows them to continue their daily activities, while receiving cancer care.
The treatment for each blood cancer differs, depending on whether it is a Leukemia, a Lymphoma or Multiple Myeloma. These are further divided into subtypes with each having a different treatment protocol based on its molecular profile and patient characteristics.
Leukemias:
Acute Myeloid and Acute Lymphoblastic Leukemias require aggressive, intensive therapy to effect a cure. High dose chemotherapy in combination with oral targeted therapy is the backbone of the treatment. Molecular characteristics and specific DNA mutations detected in the concerned patient determine which drugs would form a part of the treatment.
A number of patients will attain a cure with chemotherapy and targeted therapy alone. Patients who carry high risk mutations, those who relapse post treatment and those who are refractory to first line treatment- will require a matched Allogenic Stem Cell Transplant for a cure.
Chronic Myeloid Leukemia:
These patients carry a good prognosis. Current treatment regimens cannot provide a cure. However, the disease can be controlled, allowing patients to lead a normal life. Treatment involves an oral tablet to be taken daily. Imatinib is the drug commonly used in the first line. Relapsed and refractory patients experience an aggressive form of the disease, and require an Allogenic Stem Cell Transplant for a cure.
Chronic Lymphocytic Leukemia/Lymphoma:
These patients generally remain under close observation during the initial years of the disease. Since a cure is not possible, and the leukemia is slow growing, treatment is only initiated in case of symptoms like fever, loss of appetite, weight loss, a drop in hemoglobin or platelets or in case of organ compromise. Targeted therapy in the form of tablets is the initial treatment used, with molecular profiling guiding the treatment decisions. Chemotherapy upfront is not required.
Multiple Myeloma:
Initial treatment involves a combination of oral and injectable targeted therapy. Molecular profiling and presence of high/low risk DNA mutations determines the treatment line. Bortezomib, Lenalidomide, Dexamethasone and Denosumab are the drugs used initially. Following remission, younger patients are offered an autologous transplant while the older patients are continued on oral Lenalidomide as a maintenance. Myeloma cannot be cured, only controlled. Daratumumab is a new drug, used in the first line in patients who carry high risk mutations.
B and T Cell Non-Hodgkins Lymphoma and Hodgkins Disease:
These are classified into numerous subtypes on the basis of molecular profiling. The treatment of each subtype is different. Treatment usually involves a combination of chemotherapy and targeted therapy. Relapsed and refractory patients require a Stem Cell Transplant. Rituximab is the targeted therapy commonly used. Some of the lymphomas, like Diffuse large B cell can be cured. While slow growing lymphomas like Follicular lymphoma can only be controlled.
Living with Blood Cancer:
Adjusting to blood cancer treatment and learning to live with it can be difficult. In many patients, life long treatment is needed. The acute leukemias require aggressive, intensive therapy which is stressful and physically draining.
Support from family and close friends is essential during these times. Understanding the illness and the treatment, its duration, the side-effects and how to tackle them, all help in getting through this difficult period smoothly. Sharing a good rapport with the treating doctor is important during this entire period.
Avoiding smoking, tobacco, alcohol, exercising regularly if possible, consuming a diet rich in vegetables and fruits is essential. Crowded places must be avoided to reduce the risk of infection. A mask must be worn when out of the house as protection against air-borne pathogens.
Support & Resources:
The treating physician would be the go-to person to obtain reading material with reference to the cancer. The physician would also be able to connect the patient with other blood cancer patients. There are multiple online support groups available, depending on the specific type of blood cancer diagnosed.
Conclusion:
Blood cancer in the 21st century is a disease that can be treated. Patients must not be afraid. Staying positive and trusting the treating physician is the key. Do not be afraid to ask questions, staying informed makes the treatment easier and allows it to progress smoothly.
Being diagnosed with a blood cancer is not a death sentence any longer.