Leukemia, lymphoma, myeloma and myelodysplasia
Introduction
Hematologic malignancies are cancers of the blood, bone marrow or lymph nodes. A great deal has been learned about these diseases over the past several years, leading to new treatments and cures.
Extensive research has led to the understanding that there are many more subtypes of these diseases than was previously appreciated. Each of these subtypes behaves in its own particular way and requires its own particular therapy. Thus, accurate diagnosis of the particular subtype of leukemia, lymphoma, myeloma or myelodysplasia is critical.
Correct treatment depends on the precise diagnosis and on particular characteristics of the patient such as age, general health, etc. Treatments include mild oral chemotherapy, more aggressive intravenous chemotherapy, immunotherapy, radiation, stem cell transplantation, and experimental therapy. In some patients with very mild and slow-growing disease, a period of close observation might be appropriate.
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Diagnosis
It is now understood that there are many different types of cancer of the blood, bone marrow and lymph nodes, and accurate and precise diagnosis is critical to treatment success. The diagnosis of hematologic malignancies is made by pathologists who subspecialize in hematopathology. The UT Southwestern hematopathology laboratory (Veripath) led by Dr. Robert McKenna and Dr. Steven Kroft is renowned as one of the best hematopathology laboratories in the country. Precise and accurate diagnosis involves:
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Light microscopy – looking at the specimen under the microscope
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Flow cytometry – evaluating the surface of the cancer cell for specific abnormalities
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Cytogenetics – evaluating the chromosomes of the cancer cells for specific abnormalities
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Molecular diagnostics – evaluating the DNA and RNA of cancer cells for specific abnormalities
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Treatments
Extensive research over the past many years has led to an explosion of new therapies for leukemia, lymphoma, myeloma and myelodysplastic syndrome. These new treatments have led to control and even cure of many diseases that were previously untreatable. The field is rapidly changing, and the optimal therapy for a particular disease can change over a few months. The team physicians, as experts and leaders in the field, provide the most up-to-date therapy possible.
The correct therapy for an individual depends on the precise diagnosis and particular characteristics of the patient such as age, general medical condition, etc. Treatments for cancers of the blood, bone marrow or lymph nodes include:
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Mild oral chemotherapy. Certain diseases respond very well to this approach and can be controlled very effectively.
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More aggressive chemotherapy. More aggressive chemotherapy can cure certain cancers. Many new supportive care techniques have greatly reduced the discomfort associated with this therapy. This therapy can often be given in the outpatient clinic.
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Radiation therapy. Radiation therapy is ideal for control and sometimes cure of certain lymph node cancers. UT Southwestern has state-of-the-art radiation oncology facilities (link).
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Stem cell transplantation. Certain diseases that were previously incurable are now curable using higher doses of chemotherapy. To administer these higher doses of chemotherapy safely requires infusion of normal blood or bone marrow stem cells obtained from the patient or from a healthy donor. The UT Southwestern Program delivers stem cell transplant with excellent results. (link)
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Immunotherapy. Monoclonal antibodies target cancer cells relatively specifically and are an effective therapy for many types of hematologic malignancies.
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Radioimmunotherapy. “Radioisotopes” can be attached to monoclonal antibodies, allowing delivery of radiation directly to the cancer, sparing normal tissues. Two such “radioimmuno-conjugants” have been approved by the FDA and are available at UT Southwestern.
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Experimental therapy. In some instances, currently available approaches are not sufficient to control the cancer. Experimental therapy might be indicated in these cases. UT Southwestern has a number of experimental protocols open at any given time. Also, being fully abreast of the field, team physicians are aware of promising approaches available elsewhere and can direct patients to these other studies when appropriate.
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Careful observation. Certain blood, bone marrow and lymph node cancers are asymptomatic and are slow-growing enough that a plan of careful observation is appropriate. In many cases, such a plan can spare the patient from taking treatment for many years.
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Investigational Therapy
Investigational therapy may be appropriate for certain patients, depending on disease and patient characteristics. UT Southwestern has several ongoing clinical trials. For further information, please visit our Clinical Trials pages.
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