There was a time when the word “leukemia” meant one thing: cancer of the blood. That’s still the meaning of leukemia and lymphoma, when harmful cancer cells multiply, but today, doctors know that they come in many forms.
Each form requires its own treatment. Some respond well, even going into complete remission. Others demand aggressive attacks. A proper diagnosis is critical to successful treatment.
Strides have been made, but Dr. Robert Rice of Wellspan Medical Oncology (www.wellspan.org), Gettysburg, says that he and his colleagues see leukemia and lymphoma in adults “more often than we like.”
Types of leukemia and lymphoma
Sometimes it’s fatigue or a lump in the throat. There might be fever or a persistent cough.
“You think you have flu, and you have leukemia,” says Dr. Shyam Balepur of the Ann B. Barshinger Cancer Institute, which is part of Lancaster General Health (www.lancastergeneralhealth.org).
Other conditions show no symptoms, only appearing when routine blood tests reveal such red flags as abnormally high white blood cell counts. Leukemia and lymphoma can take a number of forms, including one of these major areas:
Chronic lymphocytic leukemia: The most common form of leukemia in adults, this leukemia can progress slowly or rapidly. Increasingly, it affects the “growing elderly population,” says Dr. Sabrina E. Martyr of PinnacleHealth Hematology/Oncology (www.pinnaclehealth.org), Harrisburg. “You may be diagnosed not because you present symptoms but because you go to the doctor’s office and have an elevated white count. That could be the first sign.”
Chronic myeloid leukemia: This leukemia is less severe than acute forms because it “doesn’t completely interfere with the development of mature red cells, white cells, and platelets,” reports the Leukemia and Lymphoma Society. Treatment advances mean that “patients who before had a two-year or three-year prognosis are now living decades on a single pill or two pills a day,” says Rice.
Acute lymphoblastic leukemia and acute myeloid leukemia: As their names imply, ALL and AML can come on suddenly, progress rapidly, and require immediate treatment.
Lymphoma, Hodgkin or non-Hodgkin: While leukemias originate in the blood and bone marrow, lymphomas originate in the lymph nodes. Many patients first see the doctor after discovering swollen glands, such as Maryland Gov. Larry Hogan, who revealed in June 2015 that he had non-Hodgkin lymphoma. Hodgkin lymphoma, characterized by a certain large cancer cell in the blood, is one of the most curable forms of cancer, according to the Leukemia & Lymphoma Society. Non-Hodgkin lymphomas take many forms and can be slow-growing or aggressive.
Treatment options
The courses of treatment are as different as the patients who register at cancer centers everywhere. Martyr calls it an algorithm, with choices made at each step depending on how the disease manifests. Rice refers to the “scaffolding” of every patient: the range of options crafted together depending on the patient’s age and condition.
Some leukemias and lymphomas still require the traditional approach of radiation, chemotherapy, or—if viable, and if a donor can be found—bone marrow transplant.
Other patients are benefiting from treatment breakthroughs. For the fairly common CLL, newer therapies are targeting “the specific pathway in the development of CLL cancer cells,” says Martyr. A similar targeted agent has been used for CML since 1995, but now CLL patients can benefit from oral drugs—no need to be hooked up to an IV—that have fewer side effects than chemotherapy.
Immunotherapies are also making inroads against ALL and CLL, says Martyr. Patients’ own healthy T cells are genetically altered to recognize cancer cells, then put back in to enlarge
the population of cancer-rejecting blood cells, she says.
Chemotherapy and immunotherapy together are a powerful combination, targeting cancerous cells while sparing “innocent bystanders, the other tissues and organs in the body,” says Balepur. “With chemo-immunotherapy combinations, we have been able to achieve robust responses and long-term disease control for most of these patients.” Lymphoma patients are showing cure rates approaching 50 percent to 60 percent, he says. Leukemia patients have a 30 to 40 percent cure rate—a good sign, “but we’re not there yet.”
Watch and wait
Often, CLL patients who show no symptoms get the “watch and wait” standard of care, says Martyr. Treatment only commences if symptoms such as fatigue or bulky lymph nodes appear, or if blood tests show worrisome trends.
It’s important to distinguish between CLL and CML, because untreated CML, often seen in younger adults, “eventually will kill you,” says Balepur. Good treatments exist that can put the condition “in long remission, to the point of clearing leukemia completely.”
Patients in treatment should be sure to manage other conditions, such as diabetes and high blood pressure. They should also rely on support networks and cancer center services to meet their physical, emotional, financial, and spiritual needs, say the experts. Family “is a vital part of the team,” says Rice. “I can recommend things, I can tell you what to do, but you have to do it.”
Future promise
Advances in immunotherapies continue to provide hope with promises of “harnessing the immune system,” says Rice. “We are seeing people doing better and living longer. Unfortunately, we still have a long way to go in these treatments. We still have a lot of work to do.”
Honesty about the prognosis is essential in any discussion with leukemia and lymphoma patients, says Martyr. But hope remains “an essential part of the treatment plan.”
“I want the best for the patient and will do everything within my power to treat that patient so they have a successful outcome.”
