Blood Cancer Treatment IN INDIA

Approximately 1.24 million people are diagnosed with blood cancer globally each year, making up about 6% of all cancer cases. This number continues to rise steadily. Fortunately, advancements in medical technology and the expertise of healthcare professionals in India have led to improved survival rates for those affected by blood cancer. Receiving a blood cancer diagnosis can be overwhelming, but with the right guidance and timely intervention, many patients can be successfully treated.

You too can become a blood cancer survivor by following the appropriate treatment plan tailored to your specific cancer stage. Blood cancers impact the blood, bone marrow, and lymphatic system, causing disruptions in cell production within the bone marrow. This leads to the excessive production of abnormal white blood cells, which disrupts the formation of other blood cells and results in various symptoms. Additionally, blood cancer cells can spread to other parts of the body, manifesting as tumors.

The good news is that blood cancer treatment has become increasingly accessible and has advanced significantly. Chronic, slow-progressing blood cancers may be managed with regular monitoring and oral medications, while aggressive and acute cases may require more intensive treatments such as chemotherapy, radiation, or stem cell transplantation. Ultimately, the recommended treatment will depend on the severity of the cancer and the individual patient’s needs and preferences.

Blood cancers, also known as hematologic cancers, arise from disruptions in blood cell production, which normally occurs in the bone marrow—the spongy tissue at the center of bones. Abnormalities in hematopoiesis lead to the growth of dysfunctional blood cells, including an increase in immature and poorly developed white blood cells. All blood cells originate from stem cells; red blood cells transport oxygen, white blood cells combat infections, and platelets facilitate blood clotting to stop bleeding. Blood cancer primarily affects the bone marrow, highlighting its critical role in overall health.

What are the different types of blood cancer?

Blood Cancer Types:

Blood cancer primarily falls into three main categories based on the type of cells affected:

1. Leukemia: This type of cancer originates from white blood cells during their formation. In leukemia, stem cells in the bone marrow produce an excessive number of abnormal white blood cells that are ineffective, leading to a weakened immune system. This condition can also result in lower levels of red blood cells and platelets. Leukemia is classified based on the cells involved:
   • Lymphocytic leukemia: This affects lymphocytes, where an overproduction of lymphoid stem cells leads to abnormal lymphocytes.
   • Myeloid leukemia: This type impacts myeloid cells, causing an abnormal increase in myeloid cells and the formation of dysfunctional myeloblasts. This results in a surplus of abnormal white blood cells alongside a decrease in red blood cells and platelets.
2. Both lymphocytic and myeloid leukemia can be acute, progressing rapidly, or chronic, developing over months or even years. The specific types include:
   • Acute lymphocytic leukemia
   • Acute myeloid leukemia
   • Chronic lymphocytic leukemia
   • Chronic myeloid leukemia
3. Leukemia tends to affect men more than women, and the age demographics vary: acute lymphocytic leukemia is most common in children and young adults, while chronic lymphocytic leukemia is typically seen in older adults. Acute myeloid leukemia can occur at any age, and chronic lymphocytic leukemia is generally diagnosed in middle-aged individuals.
4. Lymphoma: This cancer begins in the lymphocytes, where they become abnormal and multiply uncontrollably, creating more dysfunctional cells. Lymphoma is divided into two main types:
   • Hodgkin lymphoma: Here, the abnormal cells spread uniformly from one lymph node to another.
   • Non-Hodgkin lymphoma: This type spreads in a more irregular pattern.
5. Myeloma (Multiple Myeloma): Myeloma develops due to issues in the bone marrow’s production of plasma cells, which are crucial for generating antibodies that combat infections. In this condition, plasma cells proliferate abnormally, leading to the production of monoclonal antibodies that are ineffective against infections. This causes a deficiency of immune cells and antibodies, leaving myeloma patients vulnerable to infections. The disease also results in decreased levels of red blood cells and platelets, leading to anemia and increased bleeding risks. Myeloma cells can accumulate throughout the body, earning the term “multiple myeloma.” These cells can damage surrounding bones, increasing calcium levels in the blood and impaired kidney function.

What is the cost of blood cancers treatment in India?

Below is a table summarizing estimated costs of common blood cancer treatments in India, both in Indian Rupees (INR) and US Dollars (USD).

Cost Comparison Across Major Indian Cities

Treatment costs vary across metropolitan cities in India, depending on the hospital, location, and expertise available. The following table provides a comparison of estimated blood cancer treatment costs across five key cities:

How long is the stay period in India and at the hospital for Blood Cancer Treatment?

The hospital stay for blood cancer treatment in India can vary significantly depending on the type and stage of blood cancer and the specific treatment protocol (such as chemotherapy, stem cell transplant, or targeted therapy). For initial chemotherapy cycles, patients may require hospitalization for 3-7 days per cycle. If a stem cell transplant is planned, the hospital stay could extend to 3-4 weeks or longer due to the need for close monitoring and supportive care. After discharge, it is often recommended that patients stay in India for an additional 2-4 weeks for follow-up visits and monitoring for any complications, such as infection or issues related to recovery.

What are the symptoms of Blood cancer?

Symptoms of blood cancer can vary based on the severity of the disease. In acute cases, symptoms tend to be more aggressive, whereas chronic cases may present symptoms that develop gradually over time. Common symptoms associated with blood cancer include:

• Low hemoglobin levels, heart palpitations, shortness of breath, pale skin, and fatigue.
• Unexplained weight loss, persistent weakness, loss of appetite, and night sweats.
• Severe abdominal pain.
• Increased bleeding tendencies, which may manifest as bleeding from the nose or gums, easy bruising, irregular menstrual periods in women, and unusual blood accumulation.
• Visual disturbances accompanied by headaches and blurred vision.
• Neurological issues, including confusion and difficulty concentrating.
• Facial rashes are common in young children, who may also experience frequent infections.
• Frequent infections can lead to swollen lymph nodes.
• Bone and back pain is a common complaint, as weakened bones may fracture easily with minimal stress.
• A noticeable decrease in urine output, often accompanied by difficulty urinating.

Pre-Procedure

Before starting cancer treatment, the primary concern is to analyze the cancer stage. The diagnosis of blood cancer involves several key steps. It begins with a thorough medical history and physical examination, where the doctor gathers information about symptoms and checks for signs such as swollen lymph nodes. A complete blood count (CBC) is performed to analyze blood levels, including red and white blood cells, hemoglobin, and platelets, helping to identify abnormalities indicative of blood cancer. A peripheral blood smear is then conducted to examine blood samples under a microscope for abnormal cell shapes and sizes. If necessary, a bone marrow biopsy is performed to collect a sample from the hip to assess for cancerous cells. Flow cytometry may be used to analyze blood or bone marrow samples to differentiate between normal and cancerous cells. Genetic testing is conducted to identify any mutations or abnormalities, which can inform prognosis and treatment. Imaging tests, such as X-rays, CT scans, or MRIs, are also utilized to evaluate the extent of the disease and check for tumors. In some cases, a lymph node biopsy may be required if lymph nodes appear swollen. Finally, all test results are compiled to provide a definitive diagnosis, which will guide the treatment plan.

Blood cancer is determined as stages based on the level of metastasis. Metastasis is nothing but the deposition of abnormal cancer cells elsewhere in the body apart from its origin. According to the symptoms and the pace of metastasis, the various stages of blood cancer are differentiated.

Stage 1: The primary stage incorporates an increase in the lymph node size. This occurs because of the sudden abnormal multiplication of the lymphocytes. The prognosis of this stage is good considering there is no involvement of other parts of the body.

Stage 2: In the subsequent stage, the lymph nodes with the spleen and liver get involved and enlarged. With the involvement of visceral organs, the abnormal growth of lymphocytes is exceptionally high at this stage.

Stage 3: At the level of this stage, the abnormal lymphocytes hamper the production of the other blood cells like red blood cells. There is a resultant anemic condition. Also, there is a spread of metastasis to more than two organs.

Stage 4: This is the last stage of blood cancer with a high-risk proportion. The number of platelets in the blood begins to drop rapidly. The impacted cells begin harming the lungs and different organs. The organs affected earlier get severely affected.

What are the treatment options available for Blood cancer?

Stem Cell Transplantation

Stem cell transplantation is a crucial medical procedure that involves replacing diseased bone marrow with healthy bone marrow. This treatment typically requires high doses of chemotherapy or high-frequency radiation to eliminate existing cancer cells, which may be present in the bone marrow or lymph nodes. The healthy blood-forming hematopoietic stem cells are then injected through a venous puncture, enabling the production of normal and healthy blood cells necessary for the body’s proper functioning.

Stem cells can be derived from various sources, leading to different types of transplant procedures:

• Bone Marrow Transplant (BMT): Stem cells are harvested from the bone marrow.
• Peripheral Blood Stem Cell Transplant: Stem cells are collected from the bloodstream.
• Cord Blood Transplant: Stem cells are sourced from the blood of the umbilical cord.

There are two primary types of stem cell transplantation based on the donor:

• Autologous Transplantation: The stem cells come from the patient’s own body, allowing for a personalized treatment approach.
• Allogeneic Transplantation: The stem cells are obtained from a donor, which can be a family member or an anonymous donor.

The primary goal of stem cell transplantation is to replace cancerous cells with healthy ones, leading to a reduction in symptoms and an overall improvement in the patient’s quality of life.

Chemotherapy

Chemotherapy is one of the main treatments for blood cancer, employing various chemical agents to target and destroy cancer cells. This treatment is generally considered a milder form of therapy compared to more aggressive approaches, resulting in fewer side effects.

The process involves using specially designed chemicals that not only eliminate abnormal cancer cells but also inhibit their ability to multiply. Depending on the specific condition and severity of the disease, patients may receive either a single type of drug or a combination. These medications can be administered in pill form or through intravenous injections directly into the bloodstream.

Radiation Therapy

Radiation therapy is another important treatment modality used to combat cancer. It employs high-intensity radiation to kill cancer cells and prevent their overgrowth. During this procedure, patients lie on a treatment table while a large radiation machine rotates around them, focusing beams of radiation on specific areas affected by cancer.

This type of therapy is often recommended before undergoing stem cell transplantation to reduce the overall cancer burden in the body.

Targeted Therapy

Targeted therapy is designed to specifically target and destroy malignant blood cells without harming normal cells. This therapy focuses on proteins present in cancer cells to halt their growth and promote apoptosis, or programmed cell death.

Two common types of targeted therapies include:

• Monoclonal Antibodies: These agents specifically bind to cancer cells, blocking their function and aiding the immune system in identifying and attacking them.
• Small Molecule Drugs: These drugs interfere with the proliferation of cancer cells. For example, angiogenesis inhibitors prevent the formation of new blood vessels that supply nutrients to tumors, effectively starving them and causing them to shrink.

Immunotherapy

Immunotherapy harnesses the body’s immune system to identify and destroy cancer cells. This treatment can significantly slow the growth of cancer cells or eliminate them altogether. Immunotherapy sessions typically last from one week to several weeks and are usually administered through intravenous injections.

While immunotherapy is generally well-tolerated, some patients may experience side effects, which can vary based on the specific agent used. Common side effects include rashes, swelling at the injection site, headaches, muscle aches, fever, and general fatigue.

Types of immunotherapy include:

• Cytokines: These are proteins produced by white blood cells that help regulate immune responses and slow cancer growth.
• Gene Therapy: This involves introducing genetic material into cancer cells using a viral vector to induce their destruction.

Monoclonal Antibodies: Laboratory-produced antibodies that assist the immune system in recognizing and attacking cancer cells.

Post Procedure

The primary aim of most blood cancer therapies is to alleviate symptoms and reduce the growth of cancer cells. Once treatment is completed, healthcare providers conduct follow-up tests similar to those performed during diagnosis to check for any remaining cancer cells in the body.

Based on these follow-up results, additional treatment options may be recommended, tailored to the patient’s specific health status and needs.

What are the Risks & complications associated with blood cancer treatment?

The risks and complications regarding blood cancer treatment vary from person to person. Each of the cases may respond to the respective treatment differently. This may involve short term side effects and long term side effects

• Short-term side effects are experienced by the patient during the treatment or shortly after it.
• Long-term side effects may start slowly and could last for a long time. These side effects could be for a month or a year. Sometimes it may even take several years to wean off.

What is the success rate of Blood Cancer Treatment?

The success rate of blood cancer treatment depends on various factors, including the type of blood cancer (such as leukemia, lymphoma, or myeloma), the stage at diagnosis, the patient’s age, and overall health. Generally, certain types of blood cancers, like Hodgkin lymphoma, have high treatment success rates, with survival rates exceeding 85% for early-stage cases. Acute lymphoblastic leukemia (ALL) in children has also seen significant success with modern treatments, reaching survival rates above 90%. However, other blood cancers, such as acute myeloid leukemia (AML) in adults, may have lower success rates due to their aggressive nature. Treatment outcomes have been improving with advances in therapies like targeted therapy, immunotherapy, and stem cell transplantation, but individual results vary widely based on these contributing factors.