Blood droplet in water

Haematology: It’s in our blood

It constantly circulates through our bodies, delivering nutrients to our organs twenty-four hours a day, seven days a week. Comprised mainly of plasma, red blood cells, white blood cells, and platelets, our blood is vital to life.

Blood cells originally develop from stem cells, which have the potential to turn into any type of blood cell as they divide and mature. When this process goes wrong it can cause numerous problems – including blood cancer.1

The symphony of life with blood cancer
 

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A musician. A mother. A blood cancer patient.

It starts with a soft opening, then a crescendo and finally the big bang: "You have blood cancer, it may well be incurable and here is how we’re going to fight it".

It was 2012 and Kathleen was balancing a fulfilling job as a musician with a busy family life, as a mother to two young children, when doctors gave her some news that would shape the rest of her life.

Red blood cells

The fascination with blood

Johann Wolfgang von Goethe, the German poet and scientist, famously said that "Blood is a very special juice". Indeed, it has intrigued and fascinated scientists for centuries and the medical field of haematology is dedicated to understanding the secrets of how it works.

Haematology is a complex and challenging area, covering everything from cancers of the blood through to bleeding disorders such as haemophilia and complement system diseases such as paroxysmal nocturnal haemoglobinuria.

Though diverse in nature, what is common across many of these diseases is the serious impact they can have on survival and quality of life. Blood cancers alone are the fourth most common cause of cancer-related death worldwide; the three most common types of blood cancer being myeloma, leukaemia and lymphoma.2

Johann Wolfgang von Goethe

“Blut ist ein ganz besondrer Saft.” Blood is a very special juice.

Johann Wolfgang von Goethe, 1808
German poet, playwright, novelist, scientist and statesman

Branches of the same tree

Cancers of the blood are categorised into different sub-groups based on the type of cells they affect

This grouping can be imagined almost like a tree with branches – with the three main branches being myeloma, leukaemia and lymphoma. These three main types of blood cancer then split off into further branches and subtypes as well.

  • Myeloma develops from a type of cell in the bone marrow called a plasma cell. It is often referred to as multiple myeloma because it can develop anywhere in the body where there is bone marrow, including the pelvis, spine and ribcage.3
  • Leukaemia is diagnosed in more than 400,000 people each year.2 The subtype of leukaemia depends on the type of blood cell affected – red or white – and the speed of cancer growth.
    • Chronic lymphocytic leukaemia is the most common subtype of leukaemia, which progresses slowly over time, and results from a build-up of abnormal white blood cells (lymphocytes) in the bone marrow.4
  • Find out more about chronic lymphocytic leukaemia
    • Acute myeloid leukaemia  is an aggressive (fast-growing) form of leukaemia that starts in immature forms of blood-forming cells, known as myeloid cells, found in the bone marrow.5 It is the most common type of aggressive leukaemia in adults.6
  • Find out more about acute myeloid leukaemia
  • Lymphoma is the most common type of blood cancer, with over 580,000 people diagnosed worldwide every year.2 It develops when abnormal lymphocytes collect in the lymph nodes and form tumours.7
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Every 30 seconds

someone new is diagnosed with blood cancer worldwide

Lymphoma: the biggest branch

"At the time I was quite relieved they had found something. I didn’t quite realise what that would entail…I didn’t really know very much about lymphoma, I knew it was a blood cancer, but that was it."

Kathleen found out that she is one of the 580,000 people worldwide diagnosed annually with lymphoma.2

Lymphoma can be divided into two main categories - Hodgkin lymphoma and non-Hodgkin lymphoma (NHL) – both named after the physician that first classified the conditions, Dr Thomas Hodgkin.8,9

The main difference between these two types of lymphoma is that Hodgkin lymphoma affects specific lymphocytes called Reed-Sternberg cells, and is far rarer than non-Hodgkin lymphoma. NHL is the most common type of lymphoma, found in four out of five patients.2

Classification of lymphoma flow diagram
The classification of lymphoma including the number of cases diagnosed annually worldwide

Non-Hodgkin lymphoma: The right subtype means the right treatment

Over 60 different subtypes of NHL have been identified, classified as either aggressive or indolent depending on whether it is fast (aggressive) or slow (indolent) growing.10 Knowing the subtype at diagnosis is critical, as depending on the subtype, different treatment approaches are needed. 

Follicular lymphoma

Like Kathleen, Anne was diagnosed with lymphoma in 2012. Her diagnosis was the most common type of indolent (slow growing) NHL – follicular lymphoma – which accounts for 20% of all lymphoma cases.11 This type of lymphoma grows slowly and can spread unnoticed in the body. While most patients respond to initial treatment, the main challenge with follicular lymphoma is its tendency to recur, and each time the cancer comes back it becomes harder to treat.12

Find out what the patient's journey looks like in follicular lymphoma

Follicular lymphoma is generally considered incurable, the main aim of treatment is to prolong the time before a person’s disease returns (this is called a relapse).

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“The doctors helped me survive with my lymphoma, but the nurses helped me live”


Anne, Lymphoma patient


The idea of living with the condition for life is something that many patients struggle with, along with the fear of relapsing. Nearly 75% of patients experience fear of relapse following treatment, with some patients continuing to report fear of relapse more than eight years after treatment.13 

“When doctors talk about my relapsing, I find it a huge shock all over again. To me I feel well, I look well, I’m doing all the right things. Why shouldn’t I just carry on like this?”


Kathleen, Lymphoma patient
Dr Graham Collins

“The first remission is a crucial remission. Especially as we know that if patients relapse, early within two years, they have a poorer prognosis.”

Dr Graham Collins, UK

Diffuse large B-cell lymphoma

30% of newly diagnosed cases of NHL are diffuse large B-cell lymphoma (DLBCL), making it the most common type of aggressive lymphoma.14 Due to its fast-growing nature, DLBCL requires prompt treatment to stop it in its tracks before it spreads.

The ultimate goal of treatment is to cure patients, however in up to 40% of cases, the disease can return, at which point treatment options are limited and survival is short.15 Improving cure rates with first line treatment, and developing effective therapies for those who have relapsed, are key to improving long-term outcomes.

Professor Umberto Vitolo

“It’s a really bad disease. Patients who have advanced disease with symptoms, require treatment quickly. Without treatment they might only live for a few more months.”

Professor Umberto Vitolo, Italy

Helping people with haematological conditions: it’s in our blood

For more than 20 years, we have been striving to make a difference for people with blood cancers where current treatment options are limited, and there is a need for progress. Today, we continue to invest in bringing innovative treatment options to people with diseases of the blood, with the aim that we can meet their distinct needs and improve their lives.

Our commitment extends beyond developing innovative therapies, to playing a wider role in improving patient’s quality of life. We are exploring the best ways to deliver innovations to patients as quickly and effectively as possible, which includes evolving and improving how our clinical trials are designed.

Clinical endpoints are proof points and need to be evolved

A clinical endpoint is an outcome that represents a benefit for patients - such as survival, decreased pain, reduction in the number of cancerous cells, or time in remission until next treatment is needed. They play a key role in trials as they help researchers understand if a treatment is having the desired effect.

As our scientific knowledge of a disease improves, sometimes that understanding reveals an opportunity to improve the clinical endpoints we use as well.

Looking at new ways to measure treatment success

Many of today’s current treatments aim to remove most of the blood cancer from the body, however, residual cancer cells can remain in small numbers after treatment. This is known as minimal residual disease (MRD).16 These remaining cells increase the risk of a cancer coming back. Being MRD negative means that none of these cells can be detected. The use of MRD as an endpoint in clinical trials allows clinicians to assess the extent to which a treatment is working much more quickly than other conventional endpoints.

Autumn leaves

Like leaves in a swimming pool: why MRD testing is important

The importance of MRD in blood cancer

MRD testing is just one innovation we have adopted in our trials, but it won’t be the last – as our teams strive to continually deliver transformational change for patients with haematological conditions and the physicians who treat them.

We are dedicating all our efforts to doing now, what they need next.

References

  1. American Society of Hematology. Blood Cancers. [Internet; cited November 2019]. Available from: https://www.hematology.org/Patients/Cancers/.
  2. Numbers derived from Globocan 2018. World Fact Sheet. [Internet; cited November 2019]. Available from: http://gco.iarc.fr/today/data/factsheets/populations/900-world-fact-sheets.pdf.
  3. Cancer Research UK. About myeloma. [Internet; cited November 2019]. Available from: https://www.cancerresearchuk.org/about-cancer/myeloma/about.
  4. Medscape. Chronic Lymphocytic Leukemia (CLL). [Internet; cited November 2019]. Available from: http://emedicine.medscape.com/article/199313-overview.
  5. American Cancer Society. What is acute myeloid leukemia? [Internet; cited November 2019]. Available from: http://www.cancer.org/cancer/leukemia-acutemyeloidaml/detailedguide/leukemia-acute-myeloid-myelogenous-what-is-aml.
  6. National Cancer Institute. Adult Acute Myeloid Leukemia Treatment (PDQ®)–Patient Version. [Internet; cited October 2019]. Available from: https://www.cancer.gov/types/leukemia/patient/adult-aml-treatment-pdq#link/_1.
  7. American Society of Hematology. Lymphoma. [Internet; cited November 2019]. Available from: http://www.hematology.org/Patients/Cancers/Lymphoma.aspx.
  8. National Cancer Institute: Dictionary of Cancer Terms. [Internet; cited November 2019]. Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=45368.
  9. Hodgkin T. On some morbid appearances of the absorbent glands and spleen. Med Chir Trans. 1832;17: 68-114. 
  10. Swerdlow SH, et al. WHO classification of tumours of haematopoietic and lymphoid tissues. In: World Health Organization Classification of Tumours. Lyon, France: IARC; 2017.
  11. Lymphoma research foundation. Follicular lymphoma. [Internet; cited November 2019]. Available from: https://www.lymphoma.org/aboutlymphoma/nhl/fl/.
  12. Fowler N. Role of Maintenance Rituximab (Rituxan) Therapy In the Treatment of Follicular Lymphoma. Pharmacy and Therapeutics; 2011; 36:590-598.
  13. Lymphoma Coalition. Fear of Cancer Recurrence report. [Internet; cited November 2019]. Available from: https://www.lymphomacoalition.org/images/FCR_Final_Report.pdf.
  14. A clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin's lymphoma. The Non-Hodgkin's Lymphoma Classification Project. Blood 1997; 89:3909-18.
  15. Maurer, MJ et al. Event-free survival at 24 months is a robust end point for disease-related outcome in diffuse large B-cell lymphoma treated with immunochemotherapy. J Clin Oncol. 2014; 32: 1066-73.
  16. European Medicines Agency. 2014 Guideline on the use of minimal residue disease as an endpoint in chronic lymphocytic leukaemia studies. [Internet; cited November 2019]. Available from: http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2014/12/WC500179047.pdf.