Bone Marrow Transplant: An Alternative Treatment for Hematologic Cancers
Cases of cancer are increasing in recent years. If we talk about hematologic cancers, there are 3 major types: leukemias, lymphomas, and multiple myelomas. The continuous growing trend is due to abnormal cell growth within our body. Although our body has a process of dealing with these anomalies, if we have an imbalance from stress, infection, or prolonged chemical exposures, our immune system will go awry. As the mutated cells increase in number, some may become uncontrollable and turn malignant.
Currently, patients affected with hematologic malignancies are on the rise. Statistics showed that of the patients who received treatment at Wattanosoth Cancer Hospital between 2006 and 2012, there are 463 cases of lymphomas, and that number increase by 15 – 20% annually; 53 cases of myelomas, and 138 cases of leukemias and on the rise.
Stem Cell Transplant
Stem cell transplant or bone marrow transplant is considered a technological advancement that can increase life expectancy and quality of life, or better yet increase the chance of a cure for patients affected with hematologic malignancies. It requires comprehensive knowledge and experience in treatment so that patients can benefit the most. Thus, the collaboration among public and private hospitals as well as world-renowned cancer institution were established. Wattanosoth Cancer Hospital, Siriraj Hospital, and The University of Texas MD Anderson Cancer Center signed an MOU at the department level so that personnels can share knowledge on hematopoietic transplantation. This allows doctors and nurses including other related health professionals from all three institutions to work together effectively in exchanging treatment, technology and data as well as sending medical staff to study and research new treatment options, etc.
Hematologic Cancers
Professor Dr. Surapol Issaragrisil, Senior Director, Hematology Center, Wattanosoth Cancer Hospital shared about the three types of hematologic cancers: lymphomas, multiple myelomas, and leukemias.
Lymphomas
Lymphomas are considered to be the most common type of hematologic cancers in Thailand and worldwide. It is one of the top 5 cancers found in men. It is caused my abnormal cells in the lymphoid tissues and the lymph nodes. It can be separated into two main types:
- Non-hodgkin lymphoma
- Hodgkin disease (HD)
Both lymphomas have similar clinical manifestation as enlarged lymph nodes. However, NHL can often cause enlargements in other organs, such as the colon, lungs, or brain.
“In Thailand, the most common type is NHL, which can be classified into more than 30 different subtypes. Each will require different treatment regimen. So it is necessary to run a more thorough diagnostic test to find the right type in order to plan the most suitable treatment course.”
If left untreated, cancer may spread to other tissues and cause organ failure leading to mortality. As the immune system becomes compromised, our bodies’ defense mechanism against infections will decrease among other dysfunctional effects.
Some ways we can monitor for lymphomas include self-exam for lymph node enlargements in the neck, armpit, and groin areas. They may be painless, but they will gradually increase in size. Patients may have fever, night sweats, weight loss, fatigue, loss of appetite, stomach pain, nausea, and vomiting. There may be liver or spleen enlargement as well in case of organ infiltrations. Lymphomas tend to grow quite rapidly and may rupture and bleed.
The most common locations of lymph node enlargement are the neck, armpit and groin. If left untreated, the cancer may spread to other organs and may cause malfunction leading to death, reduced defense mechanism and compromised immune system.
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Multiple Myelomas
Multiple myeloma (MM) is another common type of hematologic disorders found in elderly patients. It is not quite well known and can be caused by abnormal plasma cells in the bone marrow, which is where bloods cells are produced. MM is usually found in people between the ages of 40 and 70 years old, or about 60 years old on average.
From past to present, medical knowledge is still lacking on the clear root cause of MM, making prevention and treatment difficult. However, pathophysiologic studies indicate that it may related to genetics, certain type of viral infection, as well as exposure to environmental toxins, such as pesticides or agriculture chemicals.
Signs and symptoms for MM are discernible since they do not show up in the beginning or just general fatigue. As the condition progresses, symptoms include anemia, fatigue, tiredness, and susceptibility to infections.
Treatment for multiple myeloma depends on several factors since patients tend to be advanced age and may have other comorbidities. Choices include chemotherapy or novel therapeutics, stem cell transplant, irradiation, and palliative care so that patients may return to their normal living.
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Leukemias
Leukemias occur when leukocytes divide uncontrollably to produce too much white blood cells. Many people believe that cancer is intangible, but, in reality, leukemia is in the top ten of the most common form of cancer. Today, the number of affected patients is on the rise.
Leukemias can be classified as chronic or acute types. Acute leukemias occur when young blood cells known as blasts cannot mature and they will disrupt blood cell productions, causing unusually low number of red blood cells, platelets, and white blood cells. When red blood cells decrease, patients will become anemic. When white blood cells decrease, infection becomes prevalent, while low platelets lead to bleeding. As for chronic leukemias, patients may have high white blood cell count and they will collect in the lymph nodes causing enlargements in the lymph nodes or spleen.
With the current advancement in medicine, leukemias can be treated in three methods:
- chemotherapy
- targeted therapy with tyrosine kinase inhibitors
- bone marrow transplant, which is highly effective. By using bone marrow from a close relative that genetically matches can lead to a cure.
“Bone marrow transplant can lead to a cure or cancer-free longevity. This collaboration will help us develop treatment efficiency. Medical staff can also share their knowledge, which will be beneficial to patients and Thai medical field.”
Bone marrow transplant replaces unhealthy cells or abnormal cells with healthy, normal stem cells. Since hematopoietic stem cells can be collected from three sites in the body, one of which is the bone marrow. Hence, it is often called a bone marrow transplant. Stem cells can also be collected from the blood and the umbilical cord. They can also be donated from relatives or unrelated donors (in some cases, autologous stem cells can be used).
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Hematologic stem cells will be given to the recipients through venous catheter. Patients will be prepared by receiving high-dose chemotherapy (some may also receive concurrent total body irradiation). The transplanted stem cells will grow, divide and develop into the various blood cells that are healthy.