Today, there are over one million Americans living with, or in remission from, blood cancer, including leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma and multiple myeloma.
Dr. Pamela Crilley, Chief of Medical Oncology at our hospital in Philadelphia, says: “The field of hematologic oncology is rapidly evolving, and there are quite a few new and exciting treatment options for patients with hematologic malignancies.”
Genomic profiling for hematologic cancer
Genomic profiling is a rapidly developing area of medical science. “Information about a patient’s individual tumor is helping us look at more targeted treatment options for patients,” says Dr. Crilley. Genomic testing examines a tumor on a genetic level to find the DNA alterations that are driving the growth of cancer. By examining the tumor’s genomic profile, physicians can better understand the cancer at the molecular level and tailor treatment based on these findings.
“Today, cytogenetic studies, molecular diagnostics and sophisticated pathology testing can be done using samples of a patient’s blood, lymph nodes or bone marrow to reveal a very specific, targeted treatment plan for the patient,” says Dr. Crilley. This is very important for the treatment of hematologic cancers, many of which are complex, such as non-Hodgkin lymphomas.
Promising new drug options
Many new treatments are changing the way patients with hematologic malignancies are living with the disease. Some of the disorders have been transformed into chronic illnesses that a patient can manage with ongoing treatment. Other patients with relapsed disease are being presented with new and improved options.
The FDA has approved new drugs for patients with hematologic malignancies. One exciting development is the drug ibrutinib, a selective BTK (Bruton’s tyrosine kinase) inhibitor. This oral medication is being used to treat patients with relapsed or refractory mantle cell leukemia and, more recently, chronic lymphocytic leukemia (CLL). “Ibrutinib is an amazing drug, being given for patients with advanced disease and those who have failed other treatments,” says Dr. Crilley. The drug inhibits or blocks the activity of a certain protein that may help blood cancers grow.
Another drug, obinutuzumab, a new anti-CD20 monoclonal antibody, is being used in combination with a chemotherapy drug to treat people with previously untreated CLL. The drug, which is administered via injection, is designed to selectively bind to a protein found only on malignant B-cells, to attack the cells both directly and together with the body’s immune system. This drug, says Dr. Crilley, is very promising for patients.
Tyrosine kinase inhibitor (TKI) therapy is another highly effective treatment used for chronic myelogenous leukemia (CML). “This drug has changed the natural history of the disease and is really the prototype for a lot of drugs that followed,” says Dr. Crilley. Previously, patients were typically referred for a bone marrow transplant to eradicate the disease. Now, many patients are staying in remission with this therapy and a few have even been able to stop therapy.
Advances in stem cell transplantation
A recent development in treating patients with hematologic cancer is attempting to use the patient’s own immune system and actually engineering the patient’s immune cells to target the disease. While this is under development in clinical trials, it’s another approach to eradicating any residual disease, particularly in CLL and ALL.
Stem cell transplantation, for example, has shown improved outcomes and decreased toxicity and side effects in recent years. For many patients, a stem cell transplant is the best chance for eradicating the cancer. Yet, in the past, many patients were unable to find a suitable donor for an allogeneic transplant.
“The haploidentical transplant opens up a whole new area of donors for patients,” says Dr. Crilley. The haplo-transplant is an option for patients with a hematologic malignancy who need a transplant and who don’t have a perfectly matched sibling donor. With this transplant, partially matched family members (such as children or parents) become possible candidates. In addition, donors can be sought through the National Marrow Donor Registry.
Challenges cancer patients face
Hematologic cancer patients face unique challenges. Contemplating the duration of treatment and how they will tolerate treatment can be challenging for patients. Quality of life is also a challenge, as combating short and long term side effects from treatment can make everyday life difficult. Some common side effects patients may experience include neuropathy, chronic nausea, vomiting and diarrhea. Patients may be too tired to work or to perform activities of daily living.
Survivorship is another challenge. Returning to regular life after treatment is complete can be very difficult for patients. They must adjust to returning to work, normal family life, exercise and more. There are sometimes long term effects of treatment and patients can get depressed. It’s important to get routine check-ups to maintain your health and address these challenges, says Dr. Crilley. With the help of the patient’s care team, these challenges can be met throughout treatment and beyond.
The benefits of an integrative approach
Depending on the extent of treatment, a number of clinicians should be involved in the care of a hematologic cancer patient, says Dr. Crilley. A hematologic oncologist is an important member of the care team, as well as a primary care physician to orchestrate the treatment plan. A pathologist also serves an extremely important role in defining the disease and its characteristics. If patients develop other symptoms, a pulmonary physician, gastroenterologist and surgeon may need to be involved as well.
“An integrative approach can significantly help in reducing side effects and improving quality of life for patients with hematologic malignancies,” says Dr. Crilley. It’s important to have nutritional support from the beginning. Physical therapy is also very important for hematologic cancer patients undergoing treatment, to help improve energy and physical functioning. A naturopathic clinician can also help reduce side effects of treatment.