Highlights
Significant advances in the treatment of blood cancers mean that increasing numbers are being cured of their disease
In 2010, after Doug Olson had almost given up his fight with blood cancer, his oncologist, Dr David Porter, at the University of Pennsylvania, offered him a chance to be among the first patients to try something unprecedented, known as CAR T cell therapy.
Olson was thrilled a month after his treatment when a bone marrow biopsy showed he had no more cancer cells. His doctors were happy too, but were not really convinced that the experimental therapy would prove effective in the long-term.
“We did not think this would be a curative therapy at all,” said Dr Carl June, the University of Pennsylvania researcher who helped develop the method of triggering the patient’s own immune system to fight cancer.
But more than a decade later, Olson still has no signs of the leukemia that otherwise would have killed him long ago. Now, June and his colleagues, Dr J. Joseph Melenhorst and Dr Porter feel that they’re ready to use the C-word: cure. In a paper published in Nature, the researchers report that the CAR T treatment made the cancer vanish in two out of the three patients in that early trial.
In CAR-T therapy, doctors remove some of the patient’s T cells, often considered the soldiers of the immune system, and re-engineer them in a lab to target a protein found on the surface of cancer cells. When these CAR (chimeric antigen receptor) T cells are put back in the body, they seek out and destroy cells with that protein.
If this treatment proves successful, it will be good news for all patients suffering from leukemia. In the UAE, about 4,500 new cases of cancer are reported in a year and it is the third leading cause of death. As a result of these statistics, the UAE was determined to bring down cancer fatalities by 18 per cent by last year and it is a key performance indication of the UAE National Agenda.
The type of leukemia depends on the type of blood cells that become cancer and whether it grows quickly or slowly. Leukemia occurs most often in adults older than 55, but is also the most common cancer in children younger than 15.
What is leukemia?
Leukemia in simple words, explains Prof Humaid Alshamsi, Director of Oncology Services at VPS Healthcare, is the cancer of the body’s blood-forming tissues, including the bone marrow and the lymphatic system. “Many types of leukemia exist and it usually involves the white blood cells,” says Prof Alshamsi. “The type of leukemia depends on the type of blood cells that become cancer and whether it grows quickly or slowly. Leukemia occurs most often in adults older than 55, but is also the most common cancer in children younger than 15.”
The chances of survival for a patient with leukemia depend on many factors. The term leukemia covers a wide variety of cancers and the chances of survival depend on the type of leukemia, certain prognostic markers such as cytogenetics and other molecular tests, age and the general fitness of a patient.
“Acute leukemia, in general requires aggressive treatment options and will be cured in average among 50-60 per cent of patients,” says Dr Arun Karanwal, Specialist Oncologist, Prime Hospital. “Younger patients will have better chances. Chronic leukemia such as chronic myelogenous leukemia (CML), is generally treated with oral targeted therapy and on average, up to 80 per cent of patients will achieve good control over the disease in the long-term.”
Younger patients will have better chances. Chronic leukemia such as chronic myelogenous leukemia (CML), is generally treated with oral targeted therapy and on average, up to 80 per cent of patients will achieve good control over the disease in the long-term.
Doctors can use blood tests to help detect cancer, but no single test can accurately diagnose it. Routine blood tests are essential to determine a baseline for each person. Doctors can compare subsequent blood tests against this baseline and determine whether any results are abnormal.
“Abnormal cells are called blast cells and can be seen on a simple peripheral blood smear,” says Dr Pranay Taori, Specialist Medical Oncology, Aster Hospitals UAE. “Patients having fever not routinely settling along with bleeding tendencies should undergo peripheral smear examination to check for blasts.”
Normal life after treatment
Most people look forward to the end of treatment as a time when they can re-enter life and re-establish a normal existence. While for most people life becomes a lot easier when treatment finishes, it is also a period where significant adjustments have to be made. So can you live a normal life with leukemia?
“Yes, if cured with chemotherapy or bone marrow transplant or can be chronic in some cases such as CML it can be controlled with normal life span, but again needs lifelong therapy with pills,” says Prof Humaid Alshamsi.
Patients having fever not routinely settling along with bleeding tendencies should undergo peripheral smear examination to check for blasts.
Once the treatment of leukemia is over, patients can lead a normal life, says Dr Karanwal. “Most of people will be able to work, study and do normal day-to-day routine independently. However, some regular check-ups and blood tests may be needed for a few years.”
While you can lead a perfect life once the disease is controlled, especially patients with chronic leukemia, Dr Taori has one word of caution. “Once on treatment or after, the patient should maintain proper hygiene to avoid infections as these patients have low immune status,” he says.
