Haemato-Oncology Treatment Approaches

Haematologic cancers are treated using a variety of approaches, often tailored to the specific type and stage of the disease, as well as the patient’s overall health. Here are the main treatment approaches used in haematology oncology:

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or stop them from growing. These drugs can be administered orally or intravenously and work by targeting rapidly dividing cells, which includes cancer cells. Chemotherapy is commonly used for leukaemias, lymphomas, and myelomas. The treatment is typically given in cycles, with periods of treatment followed by rest to allow the body to recover.

Radiation Therapy

Radiation therapy uses high-energy radiation to target and destroy cancer cells. It is often used for lymphomas, particularly if the cancer is localised to a specific area. Radiation can be delivered externally, using a machine that directs the radiation at the cancer, or internally, through radioactive substances placed near the cancer site.

Targeted Therapy

Targeted therapies are designed to specifically target cancer cells without affecting normal cells. These treatments work by interfering with specific molecules involved in cancer cell growth and survival. For example, tyrosine kinase inhibitors are used for chronic myeloid leukaemia (CML) to block the activity of the BCR-ABL protein that drives the cancer. Targeted therapies can be used alone or in combination with other treatments.

Immunotherapy

Immunotherapy harnesses the body’s immune system to fight cancer. It includes various approaches, such as:

• Monoclonal Antibodies: These are lab-made antibodies that specifically target cancer cells. For example, Rituximab is used to target CD20-positive B-cell lymphomas.
• Checkpoint Inhibitors: These drugs help the immune system recognize and attack cancer cells by blocking proteins that prevent immune cells from attacking the cancer.
• CAR-T Cell Therapy: This innovative treatment involves modifying a patient’s own T cells to recognize and attack cancer cells. It is particularly effective for certain types of leukaemias and lymphomas.

Stem Cell Transplantation

Stem cell transplants, also known as bone marrow transplants, replace damaged or destroyed bone marrow with healthy stem cells. There are two main types:

• Autologous Transplant: The patient’s stem cells are collected before treatment, treated, and then returned to the patient after chemotherapy or radiation.
• Allogeneic Transplant: Stem cells are obtained from a matched donor. This approach can be more challenging due to the need for a suitable donor and potential complications such as graft-versus-host disease (GVHD).

Hormone Therapy

Some blood cancers, like certain types of lymphomas and myelomas, may be influenced by hormones. Hormone therapy works by blocking or altering the effects of hormones that promote cancer growth.

Supportive Care

Supportive care focuses on relieving symptoms and improving the quality of life for patients undergoing treatment. This includes managing pain, preventing and treating infections, addressing nutritional needs, and providing psychological support. Medications to boost blood cell counts, manage side effects, and alleviate symptoms are an integral part of supportive care.

Clinical Trials

Clinical trials are research studies that test new treatments or combinations of treatments. Participating in a clinical trial can provide access to cutting-edge therapies and contribute to advancing medical knowledge. Trials often offer promising new options for patients who may not have responded to standard treatments.

Note: Treatment plans for haematologic cancers are often multimodal, meaning they combine several of these approaches to maximise effectiveness and address the cancer from multiple angles. The choice of treatment depends on factors such as the type of cancer, its stage, genetic and molecular characteristics, and the patient’s overall health and preferences.

When to see a haematology oncologist?

Seeing a haematology oncologist is important when you or someone you know is experiencing symptoms or has been diagnosed with a condition that involves blood or lymphatic cancers. Here are key situations when it is advisable to consult a haematology oncologist:

• Unexplained Symptoms: If you experience persistent or unexplained symptoms such as unusual fatigue, frequent infections, unexplained bruising or bleeding, persistent swollen lymph nodes, or weight loss, it’s important to seek a haematology oncologist. These symptoms could be indicative of a blood-related issue that requires specialised evaluation.
• Abnormal Blood Test Results: If routine blood tests reveal abnormal results, such as high or low levels of red blood cells, white blood cells, or platelets, or if there are abnormal cell shapes or counts, a haematology oncologist can provide further investigation and diagnosis.
• Diagnosis of a Blood Disorder: If you have been diagnosed with a blood disorder such as anaemia, thrombocytopenia, or a coagulation disorder, a haematology oncologist can offer specialised management and treatment options.
• Blood Cancer Diagnosis: If you have been diagnosed with a blood cancer, such as leukaemia, lymphoma, or myeloma, a haematology oncologist is essential for developing and managing a treatment plan. They specialise in the complex and specific treatments required for these cancers.
• Recurrent or Persistent Symptoms: If you have a history of blood cancer and experience a return of symptoms or new symptoms, a haematology oncologist can assess for possible relapse or complications and recommend appropriate management.
• Need for Advanced Treatment Options: If your condition requires specialised treatments such as chemotherapy, targeted therapy, immunotherapy, or stem cell transplantation, a haematology oncologist has the expertise to administer and manage these advanced therapies.
• Complex Cases or Uncertainty: When there is uncertainty about a diagnosis or if the condition is particularly complex, consulting a haematology oncologist provides access to their specialised knowledge and advanced diagnostic tools to clarify the diagnosis and develop a comprehensive treatment plan.
• Second Opinions: If you have been diagnosed with a blood cancer or a related condition and want to seek a second opinion on your diagnosis or treatment plan, a haematology oncologist can provide an expert review and alternative recommendations if needed.
• Monitoring and Follow-Up: If you are undergoing treatment for a blood disorder or cancer, regular follow-up with a haematology oncologist is important to monitor your progress, manage side effects, and adjust treatment as necessary.
• Genetic or Family History: If you have a family history of blood cancers or genetic conditions that predispose you to blood disorders, consulting a haematology oncologist for genetic counselling and early evaluation may be beneficial.

Risk Assessment in Haematology Oncology

The risk assessment in haematology oncology involves evaluating various factors that can influence the likelihood of developing blood cancers and understanding the potential severity and progression of the disease. This assessment helps in early detection, prevention, and personalised treatment planning. Here’s a breakdown of the key components involved in a comprehensive risk assessment:

Medical History

• Personal Health History: Review of any past or current medical conditions, especially those related to blood or immune system disorders.
• Family History: Analysis of any family history of haematologic cancers or genetic disorders, as some blood cancers have hereditary components.

Genetic Factors

• Genetic Testing: Identification of specific genetic mutations or chromosomal abnormalities associated with blood cancers, such as the BCR-ABL gene in chronic myeloid leukaemia (CML) or mutations in the TP53 gene.
• Family Genetic Testing: For individuals with a family history of blood cancers, genetic counselling and testing can identify inherited risks and guide early surveillance and preventive strategies.