Talk to the Expert: Dr Prem Mahendra on blood cancers
September is Blood Cancer Awareness Month, so Medstars’ Demi Sanders caught up with haematologist Dr Prem Mahendra, to find out more about blood cancers.
Prem, it’s great to chat to you. What are blood cancers?
“These are cancers that arise in the blood, bone marrow or lymphatic system. Generally, they cause the body to develop a lot of immature blood cells that don’t work properly. Blood cells are a vital part of our immune systems, so having large numbers of immature cells clogs up the blood, and stops the immune system working properly.”
Are all blood cancers the same?
“No, there are three main types of blood cancer: leukaemias, lymphomas and myelomas. Leukaemias mainly affect white blood cells and bone marrow, so they stop you being able to fight infections. Lymphomas affect your lymphatic system, which is the system that transports white blood cells around your body, and also removes waste. Myelomas affect plasma cells, which are the mature white blood cells that produce antibodies.”
How common are blood cancers?
“There are 240,000 adults and children affected with blood cancer in the UK. Despite this, I think there is more awareness of solid tumour cancers. This because they’re more common, and also because routine screening for breast and colon cancer for example, tends to raise public awareness of them. It isn’t possible to screen for blood cancer, so maybe people are less aware unless it happens to them or someone they know.”
How would I know if I had blood cancer?
“The main symptoms of blood cancers can be quite non-specific and include, fatigue, shortness of breath, recurrent infections, bleeding, bruising, swollen lymph glands, sweats, weight loss, fevers and bone pain. Whilst there are usually innocent explanations for these symptoms, it’s important to consultant your doctor if they are severe or persistent.”
How would you treat blood cancer?
“The majority are treated with chemotherapy. Some, mainly lymphomas, may be treated with radiotherapy to stop the cancer cells dividing. In blood cancer the abnormal dividing cells are blood cells or stem cells, so chemotherapy and radiotherapy may be followed by a stem cell transplant.
Stem cells have the amazing ability to grow into all the different components of blood. So one option we have is to remove and re-transplant some of the patient’s own stem cells. This is what we call an autologous transplant. The stem cells are removed and stored, strong chemotherapy is used to destroy the abnormal cells in the body, and then the stem cells are returned to the patient. This is ideal, because it means that the patient’s body won’t reject the new cells, and they will get working quickly to produce new replacement blood cells. Unfortunately, though, sometimes this isn’t enough, or isn’t possible, and then patients need a transplant from someone else.”
Where do people find stem cell donors?
“Unlike organ donation all stem cell donors are alive. We’d first look to see if you have a donor, usually a brother or sister, in your family who is a good match (HLA-compatible). If you don’t have a suitable family member we’ll look to see if we can find an unrelated donor, usually through a registry like Anthony Nolan. The majority of stem cell donors donate stem cells collected from blood, some may donate bone marrow.”
So should we all sign up for the Anthony Nolan Trust donor register, then?
“Yes, absolutely, it’s a simple procedure and you may save a life! We always need donors, and from ethnic minorities in particular. You can sign up to the Anthony Nolan register if you’re between 18-30 and in good health, and you’ll stay on the register until you’re 60. It’s so straightforward, they’ll send you a swab test in the post.”
Have there been any recent developments in the treatment of blood cancers?
“Over the last two decades, there have been tremendous advances and new treatments. This means in 2018 we are able to cure more patients than we ever could, mainly through stem cell transplantation, and patients are now living longer as a result of these treatments. However, the next two decades might see an increasing use of CAR-T cell therapy – an innovative treatment whereby your own immune system is used to try and eradicate blood cancer. The government recently approved this treatment to be administered for 30 children with leukaemia who had failed all treatments and had no other options to explore. I’m hopeful that we’re going to see exciting progress in the next few years.”
You can book an appointment with consultant haematologist, Dr Prem Mahendra, here. Prem specialises in adult blood cancers and has particular expertise in stem cell transplantation, setting up one of the largest centres in the UK.
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