As Blood Cancer Treatments Evolve, So Does The Patient Journey

Treatment for blood cancers is advancing, giving more options to people living with the disease.

Sikander Ailawadhi, MD, an oncologist and hematologist at Mayo Clinic in Jacksonville, Florida, says that physicians are identifying, monitoring and eliminating disease earlier and more deeply, thanks to targeted drug therapies and novel treatments like CAR-T cell therapy. Dr. Ailawadhi is an expert in blood cancers, particularly myeloma.

Worldwide, cancer is a leading cause of death, accounting for nearly 10 million — nearly 1 in 6 — deaths in 2020, according to the World Health Organization. New cases of blood cancers — leukemia, lymphoma and myeloma — were expected to account for nearly 10% of new cancer cases diagnosed in the U.S. in 2020.

Drug treatments for blood cancers have evolved. In the past, myeloma patients received two drugs in sequence — two after two. Now, they receive four drugs together at once, with more patients going into remission. Some treatments are becoming so effective — even after a stem-cell transplant — that a subset of patients may be able to stop their medications altogether, Dr. Ailawadhi says. Clinical trials studying that approach are underway.

Blood cancer patients have more immunotherapies available, including CAR-T, which uses the body's immune system to fight cancer. CAR-T involves genetically modifying T cells to activate the immune system to find and kill certain cancers. The Food and Drug Administration approved CAR-T for certain types of leukemia, lymphoma and multiple myeloma. The therapy is now in clinical trials as a potential option for breast, brain, pancreatic cancer, sarcoma and rheumatoid disorders such as lupus.

If patients can't receive CAR-T, they may be able to receive a class of drugs called T-cell engagers. Unlike CAR-T, T-cell engagers do not need to be manufactured. Typically, patients receive T-cell engagers on an inpatient basis. However, at Mayo Clinic, the treatment is outpatient, Dr. Ailawadhi says.

"Historically a patient who had cancer for 10 years did not suddenly go into remission and stay in remission," Dr. Ailawadhi says. "Now with these novel options like CAR-T and T-cell engagers, even patients who have had years of cancer are going into remission."

If their cancer eventually returns, patients may be able to receive treatments that were not available when they were originally diagnosed. A few years ago, Dr. Ailawadhi treated a man with myeloma from the U.K. The patient received CAR-T at Mayo Clinic and went into remission, but the disease returned about nine months later. By that time, new clinical trials had become available in the U.K. The patient started care locally and is being monitored by his Mayo team from Florida and London.

"With that time, he was able to get to more options for treatments," Dr. Ailawadhi says.

The sensitivity of diagnostic tests has advanced, allowing oncologists to tell if a patient has achieved a deep response. Tests can detect one cancer cell in 100,000 normal cells. As techniques improve, tests eventually may be able to detect one in 1 million or one in 10 million, Dr. Ailawadhi says. In the future, researchers hope to construct a predictive model that could tell patients how likely they are to achieve a depth of response, get into remission and stop their medications.

Some patients also can receive care at home. A subset of stem-cell transplant patients come to the hospital for three days of treatment, and then transition to care at home, Dr. Ailawadhi says. Medications for managing pain, nausea and other side effects of blood cancers have evolved too. Large centers may offer patients resources for palliative care, pain medicine, interventional radiology, psychology, physical therapy, and physical medicine and rehabilitation.

"It's very important to understand the patient's quality of life before the cancer," Dr. Ailawadhi says. "One of the major goals of treatment is to try to get the patient as close as possible to that again while we work to control the cancer."