New Cases, Incidence and Deaths
Drug and Radiation Therapy
Stem Cell Transplantation 
Quality of Life
Survivorship
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Blood cancers such as leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, myeloma and myelodysplastic syndromes are cancers that originate in the bone marrow or lymphatic tissues. They are considered to be related cancers because they involve the uncontrolled growth of cells with similar functions and origins. The diseases result from an acquired genetic injury to the DNA of a single cell, which becomes abnormal (malignant) and multiplies continuously. The accumulation of malignant cells interferes with the body's production of healthy blood cells.

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New Cases, Incidence and Deaths

Every 4 minutes one person is diagnosed with a blood cancer.

An estimated 137,260 people in the United States will be diagnosed with leukemia, lymphoma or myeloma in 2010. New cases of leukemia, Hodgkin and non-Hodgkin lymphoma and myeloma will account for 9.0 percent of the 1,529,560 new cancer cases diagnosed in the United States this year*.

Overall incidence rates per 100,000 population for leukemia, lymphoma and myeloma are almost identical for data reported in 2009 and 2010 [(leukemia 12.3, 2010 vs.12.2, last year); (NHL, 19.6, 2010 vs. 19.5, last year); (Hodgkin lymphoma, 2.8, 2010, same as last year); (myeloma, 5.6, 2010, same as last year)].

Leukemia, lymphoma and myeloma will cause the deaths of an estimated 54,020 people in the United States this year. These blood cancers will account for nearly 9.5 percent of the deaths from cancer in 2010 based on the 569,490 total cancer-related deaths.

Every ten minutes, someone dies from a blood cancer. This statistic represents nearly 148 people each day, or more than six people every hour. Leukemia causes more deaths than any other cancer among children and young adults under the age of 20. In general, the likelihood of dying from most types of leukemia, lymphoma or myeloma decreased from 1998 to 2007 (the most recent data available).

*Facts and statistics from Leukemia, Lymphoma, Myeloma Facts 2010-2011, in press.

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Drug and Radiation Therapy

The dramatic improvement in managing blood cancers is mainly the result of chemotherapy (anticancer drugs), usually in combinations of two or more drugs. More than 50 different drugs are now used to treat people with blood cancers and a number of potential new therapies are under study in clinical trials. People living with some types and stages of blood cancer can benefit from treatment with radiation. When radiation therapy (RT) is used, it is usually part of a treatment plan that includes drug therapy.

The type of radiation (called "ionizing radiation") that is used for RT is the same type that is used for diagnostic x-rays, but it is given in higher doses. External beam radiation is the kind of ionizing radiation used most often for therapy. Current methods of delivering RT are improved so that there is less "scatter" of radiation to nearby healthy tissues.

During the past decade, several important new drugs (and new uses for established drugs) have greatly improved blood cancer cure and remission rates for many people. Today, there are several new classes of drugs with different mechanisms of action. These drugs may be used alone for certain types and stages of disease; however, they are often combined with chemotherapy. This is important because it may mean that cancer cells—which often elude the damaging effects of chemotherapy—are less likely to be resistant (or develop resistance) to the effects of novel agents and chemotherapy given in combination.

Some of the newer classes of drugs are BCR-ABL tyrosine kinase inhibitors [such as imatinib mesylate (Gleevec®), dasatinib (Sprycel®) and nilotinib (Tasigna®)], histone deacetylase inhibitors (HDACs) [such as vorinostat (Zolinza®)], hypomethylating or demethylating agents [such as azacitidine (Vidaza®) and decitabine (Dacogen®)], immunomodulators [such as lenalidomide (Revlimid®) and thalidomide (Thalomid®)], monoclonal antibodies, and proteasome inhibitors [such as bortezomib (Velcade®)]. Many of the drugs are used to treat several types of blood cancer and are often given in various combinations of two or more drugs.

Some of the US Food and Drug Administration (FDA) approved drug therapies are:

Alemtuzumab (Campath®) is indicated as a single agent for chronic lymphocytic leukemia (CLL) treatment. It is especially active against the lymphocytes in CLL.

All-trans-retinoic acid or ATRA (Tretinoin®) in combination with chemotherapy (anthracycline antibiotic) has significantly improved the remission rate and duration of remission for people with acute promyelocytic leukemia [a type of acute myelogenous leukemia (AML)]. Arsenic trioxide (Trisenox®) also adds to the drugs available to treat this type of AML. Trisenox is indicated for people who have relapsed disease or are resistant to treatment with chemotherapy and ATRA.

Azacitidine (Vidaza) and decitabine (Dacogen) are two drugs that are indicated for all types of MDS. These drugs may help the marrow function more normally and may reduce the need for blood transfusions in some individuals with MDS.

Bendamustine (Treanda®) is a chemotherapeutic agent that is approved to treat CLL and indolent (slow-growing) B-cell NHL that has progressed during or within six months of treatment with rituximab (Rituxan®) or a Rituxan-containing regimen.

Bortezomib (Velcade) is indicated to treat people with myeloma and people with mantle-cell lymphoma who have had at least one prior therapy. Velcade in combination with pegylated doxorubicin (Doxil®) offers an important option for treating relapsed or refractory myeloma.

Cladribine (Leustatin®) induces long-term remissions in nearly 90 percent of individuals with hairy cell leukemia (HCL) who are treated at diagnosis for only one week.

Pentostatin (Nipent®) is another effective drug that can be used in people with HCL who do not respond to cladribine. There are other novel agents being studied for people with HCL who are resistant to both cladribine and pentostatin.

Clofarabine (Clolar®) is approved to treat children with relapsed or refractory acute lymphocytic leukemia (ALL) who have received at least two prior therapies. Clolar is being studied in clinical trials for adults with acute leukemia or MDS.

Dasatinib (Sprycel) is an approved "second-generation" oral drug for chronic myelogenous leukemia (CML) treatment. This oral therapy produces an excellent response in people who do not respond to Gleevec, develop resistance to it or cannot tolerate its side effects (see Imatinib mesylate).

Denileukin diftitox (Ontak®) is approved for the treatment of persistent or recurrent cutaneous T-cell lymphoma in patients whose malignant cells express the CD25 component of the interleukin-2 receptor (CD24+).

Ibritumomab (Zevalin®) and tositumomab and iodine I 131 tositumomab (Bexxar®) are two conjugated monoclonal antibodies that are approved to treat individuals with relapsed B-cell NHL.

Imatinib mesylate (Gleevec) is now the standard of care for newly diagnosed individuals with CML. Gleevec is an oral drug that blocks the oncogene-encoded protein product that allows for the development of the CML cell. The effectiveness of the drug, its tolerance by older persons and the data from the eight-plus years of study in clinical trials clearly indicate that Gleevec prolongs remission when compared to former therapies for CML. A minority of people with CML either do not respond to Gleevec, develop resistance to it or cannot tolerate its side effects. For these individuals, there are second-generation oral therapies (see Dasatinib and Nilotinib). Gleevec, Sprycel and Tasigna may also be important in the treatment of Philadelphia-positive ALL, chronic eosinophilic leukemia, certain forms of myeloproliferative diseases and systemic mastocytosis. Clinical trials are under way to determine if these second-generation drugs should be used for initial therapy for some, or all, people with CML, and if the combined use of two drugs would be better than one. A number of third-generation drugs are in early development. Some of these drugs are targeting a specific mutation in the BCR-ABL gene called "T315I." This mutation is one of the more common ones observed when a response to one of the three approved oral CML drugs is lacking or lost.

Lenalidomide (Revlimid) is approved in combination with dexamethasone to treat people with myeloma who have received at least one prior therapy. Revlimid is also indicated for the treatment of people with a specific subtype of MDS that results from a partial deletion of chromosome 5. (In addition, Revlimid appears to benefit about 20 percent of people with MDS without this specific chromosome 5 abnormality).

Nilotinib (Tasigna) is an approved second-generation oral drug for CML treatment. This oral therapy produces an excellent response in people who do not respond to Gleevec, develop resistance to it or cannot tolerate its side effects (see Imatinib mesylate).

Rituximab (Rituxan) was initially indicated for the treatment of people with indolent types of lymphoma, such as follicular lymphoma. Rituxan is now also approved to treat aggressive lymphomas, such as diffuse large B-cell lymphoma, in combination with chemotherapy. Rituxan is also used in combination with chemotherapy to treat some individuals with myeloma or CLL. Rituxan in combination with fludarabine (Fludara®) and high-dose cyclophosphamide (Cytoxan®) appears to produce high-quality responses in previously untreated individuals with CLL.

Thalidomide (Thalomid), in combination with dexamethasone, is approved for newly diagnosed myeloma.

Vorinostat (Zolinza), an agent that is approved to treat cutaneous lymphoma, is also being studied to treat people who have MDS.

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Immunotherapy. This treatment approach uses immune cells or antibodies to fight blood cancer. Immunotherapies enhance the specificity of treatment and reduce the toxic effects on healthy tissues. Monoclonal antibody therapy, cancer vaccines and donor lymphocyte infusion (DLI) are types of immunotherapy being used or being explored as treatments for people with blood cancer.

Monoclonal Antibody Therapies. Monoclonal antibody therapies are laboratory-produced proteins that can be infused, when indicated, to treat individuals with certain blood cancers. These agents target specific antigens on the surface of cancer cells. The antigens are named by "cluster designation" (CD) and number. For example, the monoclonal antibody (mAb) Rituxan targets the CD20 antigen on B lymphocytes. The mAb Campath is directed against the antigen CD52 found on T and B lymphocytes. An mAb can also be linked to a radioactive isotope to deliver radiation directly to the cancer cells. The conjugated mAbs ibritumomab (Zevalin) and tositumomab and iodine I 131 tositumomab (Bexxar) are examples of this treatment. A number of potentially effective new monoclonal antibody therapies are being studied in clinical trials for several types of blood cancer.

Experimental vaccines are being studied to treat certain types of blood cancer. The goal is to extend the duration of remission achieved by various other types of therapy. Cancer vaccines would be used in people who have small amounts of residual blood cancer after chemotherapy or stem cell transplantation. Some cancer treatment vaccines under study are intended to induce an immune response against the cancer cells present in the individual.

Donor lymphocyte infusion is used for people who have relapsed disease after stem cell transplantation for certain blood cancers, such as CML or myeloma. The infusion of the original stem cell donor's lymphocytes may induce another remission. This type of treatment is being studied intensively to learn more about the basis for this immune cell effect and to expand it for use in other types of blood cancer.

Gene Therapy. One approach to gene therapy (treatment that alters a gene's DNA or RNA) is to use agents that disable oncogenes and prevent the formation of corresponding oncoproteins. Oncoproteins cause the transformation to various types of cancer cells. For example, in CML treatment studies, researchers are trying to modify the BCR-ABL oncogene, which produces an oncoprotein that stimulates CML cell growth. (Note that the approved CML oral drug therapies, Gleevec, Sprycel and Tasigna do not alter the oncogene. These drugs work by interfering with BCR-ABL tyrosine kinase (the CML oncoprotein) and blocking its effect on the cell.)

Two other potentially important gene therapy approaches include the application of "RNA interference (RNAi)," a modality that uses molecules of RNA to silence disease-promoting genes, and "aptamer treatment," a technique that prepares small molecules in the laboratory that have the ability to inactivate disease-causing proteins. New forms of cancer therapy may be developed if RNAi can be applied to oncogenes and/or aptamer treatment can be applied to oncoproteins.

Risk-Adapted Therapy. Research is under way to identify biomarkers that may give doctors information about the type and amount of therapy needed by different patients who have the same broad diagnosis. Risk-adapted therapy may be viewed as "personalized medicine" that can be applied if there is enough information about the individual and/or the specific disease to tailor the treatment. Biomarkers may also be able to indicate which patients have a higher-than-normal risk of developing specific long-term or late effects.

Biomarkers can be high levels of certain substances in the body such as antibodies or hormones, or genetic factors that can increase susceptibility to certain effects.

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Stem Cell Transplantation

Stem cell transplantation was introduced approximately 50 years ago and is an important therapy for many children and adults who are being treated for blood cancer. The purpose of stem cell transplantation is to restore the function of the marrow (the blood-forming organ in the body). The marrow may be impaired due to the blood cancer and/or treatment.

Autologous and Allogeneic Transplantation. The main types of stem cell transplantation are autologous transplantation (the transplant patient has his or her own cells collected and infused back) and allogeneic transplantation (matched cells from a donor are collected and transplanted to the patient). For both types, stem cells are usually collected from the circulating blood, but may be collected from the marrow or, in some cases, from umbilical cord blood.

Compared to an autologous transplant, an allogeneic transplant is associated with a higher risk for serious side effects of the procedure, or death. In general, with autologous transplant there is a higher risk of disease recurrence than with a successful allogeneic transplant. The decision to do a transplant, and whether the transplant should be autologous or allogeneic, depends on the type of blood cancer, the age of the individual, the choice(s) of other effective treatment options and the availability of a stem cell donor.

To donate his or her own cells for autologous transplantation, an individual needs to have a sufficient number of healthy stem cells in his or her marrow or blood. Drugs such as plerixafor (Mozobil®), given with a white cell growth factor may be given to move stem cells from the marrow to the blood for collection and subsequent autologous transplantation.

The donor for an allogeneic transplant may be a sibling with the same tissue type as the transplant candidate (a "match"). The chance of having a full match with a sibling is about 25 percent. When a matched sibling donor is not available, a matched unrelated donor is sought through a search of the National Marrow Donor Program registry. The efforts of the National Marrow Donor Program and other donor registries have created a bank of more than 7.4 million potential stem cell donors.

Reduced-Intensity Transplantation. A modified form of allogeneic transplantation called "nonmyeloablative" or "reduced-intensity" allogeneic stem cell transplantation may be an option for people with certain types of blood cancer. If the results of ongoing clinical trials prove effective, this therapy will extend the upper age range of persons who can benefit from an allogeneic transplant.

Umbilical Cord Blood Stem Cell Transplantation. Umbilical cord blood is another source of stem cells for allogeneic transplantation, especially for children and smaller adults. To date, there have been about 6,000 cord blood stem cell transplants from unrelated donors and several hundred from sibling donors, worldwide. The National Marrow Donor Program registry includes nearly 90,000 cord blood units. The numbers of stem cells in cord blood are often insufficient for the needs of larger adolescent and adult patients. Clinical trials of transplantation with two cord blood units (double cord blood transplant) have shown promising results with more rapid engraftment than that seen with single-unit transplants, and improved survival. Researchers are also studying methods to increase the number of stem cells so that cord blood transplants will engraft faster. Expanding the number of stem cells by growing them in a test tube would especially benefit full-grown adolescents and adults.

Haploidentical Transplantation. Research is under way to improve haploidentical allogeneic transplantation. This approach is important because it has the potential to increase the number of suitable donors for children. With haploidentical transplantation, donor stem cells from a partially matched family member are used, meaning that a parent could be the donor.

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Quality of Life

Care for people with blood cancer includes providing good quality of life. Supportive care is given to prevent or treat psychosocial and physical aspects of disease and/or treatment.

Psychosocial Issues. Supportive care includes helping people with blood cancer who have depression, anxiety, a lack of information or skills, a lack of transportation or other challenges that disrupt work or school. Left unaddressed, psychosocial problems not only create or exacerbate suffering, but also interfere with treatment.

Physical Issues. Physical aspects of supportive care include the use of antibiotics, immunoglobulins or growth factors to treat infections, a common complication of blood cancer or its treatment. White cell growth factors include filgrastim (Neupogen®), pegfilgrastim (Neulasta®) and sargramostim (Leukine®). Blood transfusions may be used to treat anemia, another common side effect of the disease or treatment. Red cell growth factors such as Aranesp® (darbepoetin alfa) and Procrit® (epoetin alfa) may be used to treat chemotherapy-induced anemia in specific types of blood cancer. People who receive frequent blood transfusions may be treated with iron chelation therapy [for example, deferasirox (Exjade®) and deferoxamine mesylate (Desferal®)].

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Survivorship

An estimated 957,902 people in the United States are currently living with, or are in remission from, leukemia, Hodgkin lymphoma, NHL or myeloma.

The risk of long-term effects of anticancer therapy has been recognized for years. In response, treatments continue to evolve. To minimize the risk, the lowest effective doses of drugs and radiation are used. Regular medical follow-up is encouraged to enable doctors to assess the full effect of therapy, to detect and treat disease recurrence, and to identify and manage long-term or late effects. Survivors need physical examinations yearly or more often. Regular examinations include cancer screening and screening for long-term and late effects of treatment. Some studies indicate that few childhood survivors are aware of the kinds of therapy they received and only a small proportion receive care focused on the specific risks resulting from their prior cancer therapy.

There are survivorship programs, focusing on life after cancer, at several major hospitals around the country. Survivors do not necessarily need a cancer specialist for routine checkups and screening, but they do need to see doctors who understand their previous treatment and its risks. Coordination between specialists and primary care physicians is essential to provide the best care. Some treatment centers have follow-up clinics that provide a comprehensive, multidisciplinary approach to monitoring and supporting cancer survivors. Some follow-up clinics specialize in pediatric cancer survivors; some others follow adult cancer survivors.

The Children's Oncology Group has established Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers. While designed for children, many of the recommendations can be adapted as a starting point for adults.

Several organizations are working on guidelines for adults with blood cancer and their doctors; these guidelines will help to standardize follow-up care and increase awareness about long-term and late effects. Developing evidence-based guidelines for survivors diagnosed with cancer as adults is a complex process. One reason is that cancer survivors are a heterogeneous group; the risk for recurrence or late effects often depends on the diagnosis, stage, characteristics of their disease, the treatments received, when the treatments were given and underlying risk factors independent of their cancer or its treatment. The National Comprehensive Cancer Network (NCCN) has incorporated limited recommendations for surveillance and management of common issues facing survivors into their treatment guidelines. 

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Get More Information

For more information, please see:
Leukemia Facts & Statistics
Hodgkin Lymphoma Facts & Statistics
Non-Hodgkin Lymphoma Facts & Statistics
Myeloma Facts & Statistics

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Contact Us

The Leukemia & Lymphoma Society
1311 Mamaroneck Ave.
White Plains, NY 10605

or call the Information Resource Center at (800) 955-4572