Haematological Cancer
The haematological cancers - leukaemia, lymphoma and myeloma - are cancers arising from abnormal blood or bone marrow cells. They are rare diseases, accounting for less than 5% of all registered cancers, but have been of great interest because of major advances in treatment over the last 25 years. With modern chemotherapy, the great majority of patients go into remission and an increasing number of patients are cured.
Leukaemias are cancers of white blood cells that develop in the bone marrow. Abnormal white cells start to grow in an uncontrolled manner and production of normal blood cells is reduced. Patients often present with symptoms of anaemia, unusual bruising or bleeding, or recurrent infections. Chronic leukaemias develop slowly and are sometimes diagnosed by chance when a blood test is performed for other reasons. Simple oral drugs often control the leukaemia, and some patients need no treatment at all.
Acute leukaemias are more serious, but uncommon - in York we see at most 2 or 3 children per year and 8 to 10 adults with this diagnosis. Patients are treated with intensive chemotherapy over several months, mostly as an inpatient. The majority of patients achieve a complete remission, where all signs of the leukaemia have disappeared. However, the disease can come back in some patients. To reduce the risk of relapse, treatment in younger patients has become more intensive, with repeated courses of chemotherapy, and some patients are treated with bone marrow transplant from a brother or sister, or from an unrelated donor.
Lymphoma and Hodgkin’s Disease are cancers of white blood cells developing in the lymphatic system, usually presenting with swollen lymph glands but sometimes affecting other parts of the body. Some are “low grade” lymphomas that require only simple treatment or none at all. The “high grade” lymphomas and patients with Hodgkin’s disease need more intensive chemotherapy, sometimes combined with radiotherapy, but this can usually be given as an outpatient. If the disease relapses, patients are often treated with autologous stem cell transplant, where the patient’s own marrow cells are collected from the blood, and returned to the patient after intensive chemotherapy or radiotherapy.
Myeloma is a bone marrow cancer that can cause damage to the bones - often leading to severe back pain - and to the kidneys. It is diagnosed by taking a sample of bone marrow for analysis. Treatment is with intensive chemotherapy and younger patients are usually treated with an autologous stem cell transplant. It is not usually possible to cure myeloma, but chemotherapy can control the disease for several years.
L R Bond, Consultant Haematologist July 2004.