About "three major cancers" of blood

Three major blood cancer

In recent years, gastric cancer, lung cancer, colon cancer, breast cancer, liver cancer have been called five major cancers and became widely known about the outline of diseases. On the other hand, although blood cancer is often the theme of movies and dramas, it seems that it is still not well understood unexpectedly. It occupies most of blood cancer, and is called "three major cancers" "leukemia" "malignant lymphoma" "multiple myeloma". Among them, malignant lymphoma occurs frequently next to the five major cancers and is not a rare illness. Below, I will outline the three major cancers of blood.

leukemia

Acute leukemia
Acute leukemia is a disease that immature hematopoietic cells in the bone marrow are cancerous, normal differentiation / maturation ceases, and it rapidly proliferates. Depending on the origin of the cancer cell, it is divided into "myeloid" and "lymphatic". Although there is a difference in degree between the two, the main symptoms are all fever, bleeding, anemia, all caused by injury of normal hematopoiesis. Fever is an infection caused by leukocyte (neutrophil) reduction, bleeding is thrombocytopenia (sometimes in addition to blood coagulation abnormality), and anemia is caused by red blood cell reduction. In the case of lymphocytic leukemia, lymph nodes may swell.
Although it is a disease seen from children to the elderly, in both children and adults, neither the nature of leukemic cells nor the prognosis (course of disease) are greatly different, so it is not discussed at the same time. In the case of the same adults and elderly people, about 70% does not occur suddenly, it is characterized by the onset of the disease after a period called "myelodysplastic syndrome" of the preleukemia state. When saying leukemia, it tends to have the image that cancer cells are increasing in blood a lot. Of course there are cases like that, but cancer cells in the blood are small (it is increasing in the bone marrow), and in many cases only a decrease in normal cells is conspicuous. It is especially true in leukemia derived from myelodysplastic syndrome.
In our facility, we participate in the "Japanese Adult Leukemia Treatment Group JALSG" founded in 1987 and are conducting standard and therapeutic research. For treatment of acute leukemia, strong chemotherapy with anticancer drugs is mainstream. Treatment is quite different between myeloid and lymphatic. Both have types that are easy to cure and types that are difficult to cure depending on the type of chromosome or genetic change. For example, acute promyelocytic leukemia type has retinoic acid (vitamin A derivative) and magic acid, a magic bullet, which improves at a high rate without much administration of other highly toxic drugs. On the contrary, there are also types that are very difficult to lead to healing with existing therapies. Even if it is apparently healed (called remission), if it is predicted that recurrence will occur, hematopoietic stem cell transplantation may be added after usual chemotherapy (although it is a relatively young person and donor Is found). Recently, a part of acute myeloid leukemia was treated with an antibody (gemtuzumab ozogamicin) labeled with an anticancer agent, a part of acute lymphocytic leukemia, a tyrosine kinase Inhibitors have been used, and even this facility has been effective.
However, in acute leukemia, powerful chemotherapy with anticancer drugs is still carried out for the purpose of forcing all leukemic cells with force, even now it involves high risk of treatment itself. As the molecular pathology becomes clearer, more effective and safer treatments are being sought that stratify and individualize each type and incorporate molecular target therapy.

Chronic leukemia
Chronic leukemia also has "myeloid" and "lymphatic" depending on the cell from which it originates. "Chronic lymphocytic leukemia" is a very popular disease in Europe and the United States, molecular-level pathological analysis and treatment are progressing rapidly. However, it is one of the rare diseases in Japan, so I will only talk about "chronic myelogenous leukemia" below.
Even in chronic myelogenous leukemia, immature hematopoietic cells (hematopoietic stem cells) in the bone marrow are cancerous as well as acute myelogenous leukemia. The difference is that cancer cells maintain their ability to differentiate and maturity. However, if the life expectancy comes first, the cells that are supposed to die will survive through cancerification, and will gradually increase in the body as a result. Therefore, the progress of the disease is slow and there are few symptoms in the early stages of the disease. Therefore, in the blood test of medical examination, incidentally, it is almost always found that it is pointed out an increase in white blood cells and platelets. However, as it progresses, the spleen and liver will swell. Also, although it is chronic, there is a time when cancer cells start to proliferate abruptly (blast crisis).
The causative gene and molecular abnormality are well understood, and the tyrosine kinase inhibitor TKI, which is a representative of molecular targeted drugs, is a so-called magic bullet. It is the first time that this medicine has been used for more than ten years, but very good therapeutic effect can be obtained for a long time. Even at this facility, we are using it from the time of its release, but all the patients are still fine now. Even after that, highly effective TKI has been developed one by one, and it is used separately considering various conditions of patients. However, among many patients, it becomes TKI resistant by mutation of further genes, TKI therapy can not be adequately treated due to side effects, and an example of shifting to the stage of treating a very difficult acute inversion there is. At that time, other hematopoietic stem cell transplantation is indicated.

Malignant lymphoma
Malignant lymphoma is a disease that lymphocytes, a type of leukocyte, become cancerous and increase, and unlike leukemia, it has the property of forming lumps. Subjectively, lymph nodes such as the neck, armpits, and the base of the foot are swollen and often found, but since lymphatic tissues are distributed throughout the body, it does not matter where they come from anywhere in the body. Sometimes it involves general symptoms such as fever, weight loss, night sweats. Hodgkin's lymphoma and non-Hodgkin's lymphoma are classified roughly, but in Japan, Hodgkin's lymphoma is less than 10%, and non-Hodgkin's lymphoma accounts for the majority.
Non-Hodgkin's lymphoma is distinguished by being called B cell type, T cell type, NK cell type etc depending on the type of lymphocyte derived. Furthermore, it is classified into many kinds from the difference of pathological tissue image, chromosome, gene, cell surface trait etc. Why is this cumbersome and difficult classification necessary? Although bad lymphoma is a malignant lymphoma, it is diversified from a rapidly progressing type to a slowly advancing type on a yearly basis, and is immediately hospitalized and requires treatment In some cases it may be better to observe without treatment for many years. Of course, the treatment medicine will also be different.
Diagnosis includes "pathological diagnosis" in which lesion sites are examined excised "biopsy" and investigated, "staging" by PET / CT and others. Both are essential for definitive diagnosis, treatment policy decisions, prognostic predictions, etc. First and foremost the first diagnosis is very important.
For treatment, chemotherapy which combines multiple anticancer drugs is common. In the case of B cellularity, it has become possible to combine rituximab, an antibody against the cell surface antigen, and the treatment outcome has improved greatly. Antibody therapy called Mogamurizumab may be used for T cellularity, especially in adult T cell leukemia / lymphoma with high malignancy. In malignant lymphoma, radiotherapy is also generally effective, but it is mainly done as supplementary treatment. Depending on the case, there is also a method of treating the radioactive isotope with an antibody labeled. If recurrence occurs or the possibility of recurrence is high, the selection of autologous hematopoietic stem cell transplantation may also be considered. Even in malignant lymphoma, the elucidation of the molecular pathology has advanced, and various molecular targeted drugs, including therapeutic drugs that control intracellular signals, have been developed and it is nearly impossible to put it into practical use in Japan.

Multiple myeloma
Multiple myeloma is a disease in which "plasma cells" are cancerous and increase mainly in the bone marrow of the whole body. Plasma cells are cells differentiated and matured from lymphocytes (B cells), a type of leukocyte, and originally are cells that make "antibodies" (proteins called immunoglobulins) that protect the body from pathogens. Normally, cancerous cells also maintain this characteristic, so antibodies called M protein are detected in blood and urine (although this antibody is not resistant)
Elderly people, especially men Many diseases, it is increasing every year. The most common symptom is bone pain. The main reason is that cancer cells are increasing while destroying bones, in fact, the bones of the whole body are weak and easily breakable. Gradually, normal hematopoiesis is injured, anemia, leucopenia, thrombocytopenia, etc. occur. Symptoms due to renal disorder, immunodeficiency (decreased resistance), hypercalcemia are also characteristic of this disease. However, recently, it is asymptomatic and sometimes happens to find the aforementioned M protein.
Treatment regimen will be decided taking into consideration factors such as age (degree of progress), age, general condition of the condition. If there is no organ injury early in the disease, it is standard to follow without treatment. From the general concept of cancer, "early detection and early treatment", there may be many who feel strange, but considering the nature of this disease, that person is better (though There is a possibility that the way of thinking will change). Currently, only the patient who has an organ disorder called "symptomatic myeloma" is treated. And for patients with relatively young (under 65 years), without serious complications and with normal cardiopulmonary function, consider (1) high-dose chemotherapy plus autologous hematopoietic stem cell transplantation. For other patients ② Perform standard dose chemotherapy.
Recently, effective drugs used in (1) transplantation introduction therapy and (2) standard amount chemotherapy have appeared. Thalidomide, bortezomib, lenalidomide are three drugs. Each one alone or in combination with existing or new drugs shows a very good therapeutic effect and an obvious survival extension is seen. Even at this institution, we actively treat these drugs with full use of these drugs. More effective administration methods and development of more effective medicines are underway, and treatment methods are changing year by year.

To the end
Over, I have reviewed the three major blood cancers. There is no alternative that any disease is a life-threatening scarier, but the treatment is steadily progressing. Especially, recently, it is called "molecular target drug", and a series of medicines that are targeted for cancer cells and their genetic and molecular abnormalities unique to their environment are drawing attention. Some of these drugs have pushed up conventional treatment results at once and changed standard treatment. On the other hand, problems such as new side effects and expensive drug expenses are occurring. Including these problems, we can not keep an eye on trends in the development of new therapies.
Since its establishment, Kumamoto City Hospital Blood and Tumor Internal Medicine has seriously taken care of these three major blood cancers. Since the establishment of this department, we are aiming for more accurate diagnosis by combining flow cytometry, chromosome / genetic diagnosis, etc. in addition to cell / pathological diagnosis. In treatment, we introduced the molecular target therapy early, including introducing and succeeding peripheral blood stem cell transplantation method for the first time in 1992 in Kumamoto prefecture. Continue, we will endeavor to provide the latest and best treatment appropriate for each patient.