Blood cancers are a diverse group of diseases, also known as ‘hematological malignancies.’ This means the cancer usually arises in the bone marrow and lymphatics and spreads to impact the formation and function of blood cells.
Dr Govind Eriat, Consultant- Hemato-Oncologist & Bone Marrow Transplant, Gleneagles Hospitals, says, “The cancer affects a certain stage of the blood cell production pathway called the normal ‘cell cycle’. This starts with the blood stem cell and ends in either a red cell, white cell, or a platelet. Depending on where in the cell cycle the error occurs, a distinct clinical and pathological entity is affected.”
Errors closer to the blood/hemopoietic stem cells usually produce an acute Leukemia. Dr Eriat says, “Chronic leukemias are produced by errors different from acute leukemias in the chain of events. The acute leukemias are aggressive diseases warranting urgent medical attention. ‘Lymphoma’ is affected by production errors downstream in the lymphocyte production stage, which is a subtype of white cells. These are heterogeneous diseases and have several types depending on specific mutations. The myelomas affect B cells, which produce an excess and uncontrollable amount of antibodies.”
The success of treatment often depends on timely diagnosis, followed by initial chemotherapy or immunotherapy, followed by an allogeneic blood stem cell transplantation, among high-risk diseases like acute leukemias. The low. Risky leukemias don’t need an allogeneic BMT. As opposed to allogeneic BMT, where a matched donor is needed for a successful transplant, high-risk lymphoma and most myelomas need an autologous BMT, where the patient with disease-free marrow can give his own stem cells for the treatment. Cancers of the blood have several symptoms, and not all of them may be visible from the surface.
Dr Eriat lists five critical Blood Cancer symptoms to watch for:
– Enduring Mild to Moderate Fevers and Suffering from Frequent ‘Coughs and Colds’
The protection that all of us share from the external environment is provided by what is known as the immunological system. This is a function of the myriad variety of white cells produced by the marrow. When it gets impacted, you start having blood cancer, and also shrink the population of the white blood cells or antibodies. Dr Eriat reveals, “When this happens and remains untreated, there is a cycle of illness that keeps occurring. You may start suffering from recurrent infections ranging from coughs and colds to more serious infections.”
– Tiredness
“If you start to feel excessively tired and weak, even after sleeping properly and having a good diet, you may be affected. The low or high white cell count produces unusual tiredness and affects all organ functions at the cellular level. This is usually accompanied by anemia, which amplifies the issue,” he further explains
– Bone Pain and Lymph Nodes That Are Swollen
With lymphoma or ALL type of leukemia, a lump in the neck, armpit, or groin can be present and persistent. Nodes that are swollen with a painful bone are overlooked. Multiple myeloma is another condition that weakens the bone structure and produces bony pains and leading to fractures or kidney and nerve damage.
– Losing Weight Unexpectedly and Sweating Severely at Night
Rapid weight loss and sweating at night may be indicators of severe medical problems. Fever, night sweats, and sudden weight loss are “B symptoms,” and there is an internal struggle against some malady.
– Bruising
Almost all the blood cancers produce bleeding and easy bruising. This is because of a downstream decrease in platelet function and coagulation protein dynamics.
The Critical Need for Blood Stem Cell Transplantation
Dr Eriat says, “For patients who are diagnosed with blood cancer and receive a stem cell transplant, a real chance at a cure is possible. In such allogeneic transplants, a fully matched donor is at the crux of the best outcomes. The stem cell from a matched donor restores depleted immune function and the blood cell production. Such a donor would usually be found in the siblings. But with the advent of nuclear families, finding a fully matched related donor is not possible for many.”
“In such scenarios, we look for an unrelated fully matched donor or a MUD. Another human being with exactly the same genetic makeup as the patient can be found through the unrelated donor registries available worldwide. Finding such a donor is the most important part of the transplant process.”
The Increasing Need for Donors
In India, more than 70 thousand people die of blood cancers every year, which is 8% of the new cancer cases. Being able to trace an HLA-discordant or MUD donor is often the most successful treatment strategy. Unfortunately, only 30% of blood cancer patients will be able to find a blood relative. Of the remaining 70% who are dependent on matches with unrelated donors, only 0.09% of the Indian population are registered as donors. The chances of landing a fully matched donor from a specific ethnic pool or haplotype which is endemic, like a south Indian patient is extremely challenging without volunteers from the same ethnic pool
signing up.
In India, there is a very low supply of voluntary donors for simple blood products like packed red cells and platelets, and this is exaggerated in the stem /blood stem cell donors enthusiasm. This means that patients with leukemia or aplastic anemia, and in advanced stages, have a very low survival rate without a matched donor to take them through a transplant. Dismal representation of the Indian haplotype in the world registries screams of our apathy towards volunteering ourselves for a cause that can provide a lasting cure for many.
Till such a matched donor is sought, patients are forced to wait a long period of time or seek help from second-degree relatives who are unlikely to match or opt for a half-matched or mismatched BMT, which produces poorer outcomes and more morbidity.
What can we do?
Any Indian above the age of 18 can be a donor, provided they don’t have active cancer, connective tissue disorders or any other life-threatening illness. Diabetes is a relative contraindication that the treating transplant physician may allow, depending on the acuity.
Increased awareness to participate in and actively support donor registrations to ensure a wider reach to patients who are in desperate need of treatment to save their lives. The interested donors just need to start with a cheek swab. Further blood tests are done only if you get a call from. The registry in case of a match. The stem cell collection process is an extremely safe and simple outpatient procedure. The cell function recovers within 3 months usually. The donor has no long-term or short-term morbidity. Dr Eriat concludes, “We need more Indians to volunteer so that deserving Indian patients can get a better chance at getting a fully matched donor for a safe transplant.”