Blood Cancer Awareness Month

September is Blood Cancer Awareness Month. In honor of all the patients who have fought and are currently fighting these diseases, the Paris Charter Against Cancer would like to contribute to the discussion and present some facts about the disease as well as what you can do to decrease your risk of being diagnosed with Blood Cancer.

What is Blood Cancer?

Blood cancer is a category of cancers that affect your blood cells. It includes several types of cancers, such as leukemia, lymphoma, myeloma, myelodysplastic syndromes (MDS), and myeloproliferative neoplasms (MPN).

Leukemia

Leukemia is a term that covers multiple cancers of the blood cells, particularly those affecting the blood-forming tissues of the body, such as the bone marrow and lymphatic system. It involves the uncontrolled growth of abnormal white blood cells, which crowd out normal blood cells. These abnormal cells can’t function properly, leading to problems with infection, anemia, and bleeding.

When making a diagnosis, leukemia often receives two classifications. First, it is classified as either acute or chronic, which determines how fast the cancer is progressing. Acute leukemia progresses rapidly and requires immediate treatment, whereas chronic leukemia develops more slowly and can take years to cause symptoms. The second classification determines what cells are affected. It is either lymphocytic, in which the lymphoid cells are affected, or myelogenous, in which the myeloid cells are affected.  

Types of leukemia:

• Acute Lymphoblastic Leukemia (ALL), which is common in children younger than 15 and adults older than 50.
• Acute Myeloid Leukemia (AML), which affects both adults (typically over 60 years of age) and children.
• Chronic Lymphocytic Leukemia (CLL), which mostly affects older adults over 65, but can be found in adults as young as 35.
• Chronic Myeloid Leukemia (CML), which usually occurs in adults.

Lymphoma

Lymphoma is a type of cancer that begins in the lymphatic system, which is part of the body’s immune system. The lymphatic system includes the lymph nodes (small glands), spleen, thymus, and bone marrow. Lymphoma occurs when lymphocytes (a type of white blood cell) grow uncontrollably, leading to tumors in the lymph nodes and other organs.

Types of Lymphoma:

There are two main categories of lymphoma, based on the type of lymphocytes involved:

1. Hodgkin Lymphoma (HL): This type of Lymphoma is characterized by the presence of Reed-Sternberg cells (abnormally large B lymphocytes) and it is the more uncommon type, but generally more treatable.

2. Non-Hodgkin Lymphoma (NHL): This type includes a diverse group of cancers that affect B lymphocytes, T lymphocytes, or natural killer cells. It is the more common type of lymphoma and can be fast-growing (aggressive) or slow-growing (indolent), depending on the specific subtype.

Myeloma

Myeloma, also known as multiple myeloma, is a type of blood cancer that originates in plasma cells, a type of white blood cell found in the bone marrow. Plasma cells are an important part of the immune system, responsible for producing antibodies that help fight infections. In myeloma, these plasma cells become cancerous, multiply uncontrollably, and produce abnormal proteins, which can cause damage to the bones, immune system, kidneys, and red blood cell count.

How Myeloma Works:

In healthy individuals, plasma cells make antibodies to fight infections. In multiple myeloma, cancerous plasma cells produce large amounts of abnormal antibodies called monoclonal proteins (or M proteins), which don’t help fight infections. These proteins accumulate in the body and can cause damage, particularly to the kidneys. At the same time, the overproduction of cancerous plasma cells crowds out healthy blood cells in the bone marrow.

Types of Myeloma:

1. Multiple Myeloma: The most common type, affecting multiple areas of the bone marrow.
2. Smoldering Myeloma: A slow-growing or inactive form of myeloma that doesn’t cause symptoms immediately.

2. Solitary Plasmacytoma: A single mass of cancerous plasma cells in one part of the body (often the bone or soft tissue).

For more info on Myleoma please see here.

Myelodysplastic Syndromes (MDS)

Myelodysplastic Syndromes (MDS) are a group of rare blood disorders where the bone marrow, which produces blood cells, doesn’t function properly. In MDS, the bone marrow produces immature or defective blood cells, which either don’t mature or die off prematurely. This leads to a shortage of healthy blood cells in the body, resulting in conditions like anemia (low red blood cells), neutropenia (low white blood cells), and thrombocytopenia (low platelets).

Types of MDS:

MDS is categorized based on which blood cells are affected and how severely they are affected:

1. Refractory Anemia (RA): Low red blood cells, leading to anemia.
2. Refractory Cytopenia with Multilineage Dysplasia (RCMD): Deficiencies in multiple blood cell types.
3. Refractory Anemia with Excess Blasts (RAEB): High numbers of immature blood cells (blasts) in the bone marrow.
4. MDS with isolated del(5q): Involves a specific genetic mutation (deletion on chromosome 5).

MDS can vary from mild to severe, and in some cases, it may progress to acute myeloid leukemia (AML), a type of aggressive blood cancer.

Myeloproliferative Neoplasms (MPN)

Myeloproliferative Neoplasms (MPN) are a group of blood cancers in which the bone marrow produces an excessive amount of one or more types of blood cells, including red blood cells, white blood cells, or platelets. These cancers result from mutations in the bone marrow stem cells, leading to uncontrolled growth and overproduction of mature blood cells. Over time, MPNs can cause complications like blood clotting, bleeding, and progression to other serious conditions, such as myelofibrosis or acute myeloid leukemia (AML).

There are several types of MPNs, each affecting a specific type of blood cell. The three most common are:

1. Polycythemia Vera (PV): This type is characterized by the overproduction of red blood cells, sometimes along with increased white blood cells and platelets. It can lead to increased blood viscosity (thickening of the blood), causing a higher risk of blood clots, strokes, and heart attacks.
2. Essential Thrombocythemia (ET): This type of MPN involves the overproduction of platelets, which can lead to abnormal clotting or, paradoxically, bleeding problems. In some cases, patients experience bleeding in areas like the gastrointestinal tract despite having a high platelet count.
3. Primary Myelofibrosis (PMF): This type involves the abnormal production of connective tissue in the bone marrow (fibrosis), which impairs the bone marrow’s ability to produce normal blood cells. It can lead to anemia (low red blood cells), splenomegaly (enlarged spleen), and an increased risk of progression to AML.

Other Types of MPN:

• Chronic Myeloid Leukemia (CML): A type of MPN where there is overproduction of white blood cells, driven by a specific genetic mutation called the Philadelphia chromosome (BCR-ABL gene).
• Chronic Neutrophilic Leukemia (CNL): A type categorized by the overproduction of neutrophils, a type of white blood cell.
• Chronic Eosinophilic Leukemia (CEL): A type categorized by the overproduction of eosinophils, another type of white blood cell.

Risk Factors

Leukemia

The exact cause of leukemia is often unknown, but factors like genetic mutations, exposure to radiation or chemicals, smoking, and certain inherited conditions can increase the risk.

Certain inheritable genetic syndromes also appear to increase the risk for AML. These include: Fanconi anemia, Diamond-Blackfan anemia, Bloom syndrome, Li-Fraumeni syndrome, Neurofibromatosis, Kostmann syndrome, Ataxia-telangiectasia, and Shwachman-Diamond syndrome.

Lymphoma

The exact cause of lymphoma is often unknown, but certain risk factors increase the likelihood of developing it, including:

• Age: Hodgkin lymphoma is more common in young adults, while non-Hodgkin lymphoma is more common in older adults.
• Weakened immune system: Immunosuppressive conditions (like HIV or organ transplants) increase the risk.
• Infections: Certain viral infections like Epstein-Barr virus (EBV) or Helicobacter pylori can increase lymphoma risk.
• Genetic factors: Family history can play a role.
• Exposure to radiation or chemicals: Such as pesticides or herbicides.

MDS

The exact cause of MDS is often unclear, but it can result from genetic mutations or be related to environmental factors. It can be classified into two categories:

• Primary MDS: when the cause is unknown.
• Secondary/Post-treatment MDS: when MDS is caused by prior exposure to chemotherapy, radiation, or chemical toxins like benzene.

Risk factors include:

• Age: Most cases are found in people in their 70s or 80s. MDS is uncommon in people younger than 50.
• Sex: For unknown reasons, MDS is more common in men.
• Previous cancer treatments
• Genetic conditions such as Fanconi anemia, Shwachman-Diamond syndrome, Diamond Blackfan anemia, Familial platelet disorder with a propensity to myeloid malignancy, Severe congenital neutropenia and Dyskeratosis congenita have also been linked with MDS.

MPN

The precise cause of MPNs is not fully understood, but most cases are linked to genetic mutations in the bone marrow cells. The most common mutation involved is in the JAK2 gene, found in most cases of PV and many cases of ET and PMF. Other mutations, such as CALR and MPL, may also be present.

Some studies have shown that exposure to high levels of radiation and certain toxins like benzene present an increased risk of developing myeloproliferative neoplasms, like polycythemia vera, primary myelofibrosis, and chronic myelogenous leukemia.

Prevention & Screening

Leukemia

Because the exact cause of Leukemia is unknown and there are different types, preventing leukemia and regularly screening for it is difficult. There are some general things you can do to reduce your risk of leukemia, such as:

• Avoiding the consumption of tobacco products and alcohol
• Maintaining a healthy weight
• Maintaining a regular exercise regimen
• Eating a diet rich in fruits and vegetables and low in processed meats

Lymphoma

There are a number of things that can be done to reduce your risk of lymphoma, particularly non-Hodgkins lymphoma.

• Avoid exposure to viruses such as the human T-cell lymphotropic virus (HTLV-1), the Epstein-Barr virus, and HIV.
• Preventing a Helicobacter pylori infection, as there are linkages between H. pylori and a few lymphomas of the stomach.
• Avoid exposure to chemicals such as pesticides and herbicides, as well as radiation.
• Making several lifestyle changes such as avoiding the consumption of tobacco products and alcohol, maintaining a healthy diet, and maintaining a regular exercise regimen.

MDS

There are a number of things that can be done to reduce your risk of developing MDS.

• Avoid exposure to chemicals and radiation: certain types of MDS can be caused by previous cancer treatments.
• Avoiding the consumption of tobacco products as smoking is one of the risk factors for MDS.

MPN

As oftentimes MPN is linked to genetic conditions, there is not much in terms of prevention that can be done. However, reducing exposure to toxins like benzene and radiation may be effective, as studies have shown a linkage between MPN and exposure to these factors.

Statistics

• In 2022, Non-Hodgkin Lymphoma was the 10th most common cancer, with 553,389 new cases globally
  • Leukemia was the 13th most common with 487,294 new cases.
  • Other forms of Blood Cancer such as Multiple Myeloma and Hodgkin Lymphoma ranked 21st and 26th respectively.
• According to the World Cancer Research Fund International 2022 Cancer statistics, non-Hodgkin lymphoma and Leukemia are more prevalent in men (ranking 8th and 9th most common) than women (ranking 10th and 12th).
• According to the Leukemia & Lymphoma Society, in the United States every 3 minutes, one person is diagnosed with a form of Leukemia, Lymphoma, or Myeloma
• In 2022, Leukemia was responsible for over 300,000 cancer-related deaths.