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 affects the body’s ability to form blood tissue correctly. It also affects the bone marrow and the lymphatic system. White blood cells are one of the body’s main defenses against infection, but those that suffer have bone marrow that produces abnormal white blood cells that are unable to fight infection effectively. Depending on the type and specific diagnosis a stem cell transplant may be recommended.

 – There are four main categories of Leukemia: Acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML), and chronic myeloid leukemia (CML). The main differences in these categories are where cancer began and how quickly it grows or spreads in the body. Acute myeloid leukemia is the most common form of acute Leukemia. In this disease, certain cells found in the bone marrow, called blast cells, do not mature correctly. The cells are still formed but are not able to ward off infection as non-diseased blast cells normally would.

 – Researchers cannot point to an exact cause but it is currently thought to arise from a combination of environmental and genetic factors. Some unknown type of mutation occurs at the cellular level causing the mutated cells to spread throughout the body. Smoking, working with chemicals, such as Benzene, previous cancer treatment (chemotherapy and radiation), are all risk factors.

 – Symptoms are often vague making it difficult to spot. If you have any of the following signs and symptoms especially for a prolonged period it is a good idea to consult a doctor: weight loss you can’t explain, fatigue, reoccurring infections, unexplained bruising, bleeding easily, bone pain, bone tenderness, recurring nosebleeds, fever or chills (unrelated to another illness), sweating, or swollen lymph glands.

Cancer Horizons strives to gather information about leukemia and present it in plain and understandable terms. If you have an article or other content to refer to us or wish to contribute content please 

A panel of experts on chronic myeloid leukemia discuss common patient concerns, adverse effect considerations, and best practices for setting clear expectations.

Open Dialogue in CML Care: Setting Expectations, Managing Side Effects, and Optimizing Patient Quality of Life

This program was made possible with support from Novartis Pharmaceuticals.

Video content above is prompted by the following questions:

What are some of the most common concerns or questions newly diagnosed CML patients may have about their initial treatment plan?

What are some common adverse effects or tolerability challenges patients may experience with their initial treatment plan?

What is your best practice to set clear expectations with your patients on what they may experience along their CML journey?

Food and Drug Administration (FDA) approval of Kymriah

 (tisagenlecleucel) for the treatment of certain children and young adults with acute lymphoblastic leukemia, marking the first FDA-approved CAR-T cell therapy for patients with cancer.

Over the past half decade, six CAR-T cell drugs gained FDA approval for various types of leukemias, lymphomas and multiple myeloma, drastically changing the treatment paradigm of patients with blood cancer.

The Food and Drug Administration (FDA) approved the first CAR-T cell therapy, Kymriah (tisagenlecleucel), five years ago. Since then, the FDA has approved five more CAR-T cell therapies to treat leukemias, lymphomas and multiple myeloma. To commemorate this milestone, CURE® and its sister publication Cancer Horizons put together an article offering insight into what CAR-T cell therapies are, and how they work. 

CAR-T cell therapy uses a patients’ own immune system to attack the cancer.

“In CAR-T cell therapy, the ‘CAR’ means chimeric antigen receptor,” 

Dr. Jordan Gauthier of Fred Hutchinson Cancer Center

 in Seattle said in an interview with CURE®. “We use one white blood cell type we call T cells and, we engineer them in the lab to express this new receptor that we call CAR … so we ‘cook’ the cells in the lab until we have enough of them, and then we put them in a bag and infuse them.”

Of note, Gauthier was a member of the Seattle Cancer Care Alliance at the time of the interview. In April, the Seattle Cancer Care Alliance and Fred Hutchinson Research Center united to become one organization known as the Fred Hutchinson Cancer Center.

The CAR-T cell therapy process starts with a blood draw so that clinicians can collect the patients’ white blood cells. The T cells will then be specially engineered to find and attack cancer. Once the killer T cells are made, they will be multiplied.

While T cells are being created, the patient will undergo conditioning chemotherapy treatment, which will kill off other immune cells, essentially “making room” for the engineered T cells to proliferate within the body.

Once the T cells are engineered and the patient has finished conditioning treatment — a process that typically takes a couple of weeks — the CAR-T cells will be infused back into the patient.

At this point, patients and their health care team must 

, namely neurotoxicity (impairment to brain function) and cytokine release syndrome (the release of too many inflammatory molecules into the blood) — both of which could be serious if not caught early.

While prior studies have shown that the majority of patients undergoing CAR-T cell therapy will experience side effects, ongoing research is trying to determine which patients are 

After patients leave the hospital after the side effect monitoring period is over, they may not need to return for more treatment, as CAR-T cell therapy often offers patients a 

 with lasting efficacy and cancer control, explained Dr. Lori A. Leslie, director of the Indolent Lymphoma and CLL Research Program at John Theurer Cancer Center in Hackensack, New Jersey.

 may qualify for CAR-T cell therapy, researchers are still studying 

, as well as investigating CAR-T cell therapy’s potential in different cancer types — 

Additionally, this summer, the FDA agreed to speed up their review of a 

 to treat rare forms of lymphoma and leukemia.

“We've started to see some patients with very long-term remissions now from CAR T. So I'm excited to see the how that field evolves in the coming years,” 

said Dr. Matthew Davids, of the Dana-Farber Cancer Institute

 in Boston, in an interview with CURE®. “I'm excited to see the how that field evolves in the coming years.”

For more news on cancer updates, research and education, don’t forget to 

Over the past five years, CAR-T cell therapy has improved outcomes for many patients with blood cancer. Here’s what patients need to know about the immune-based treatment.

What Is CAR-T Cell Therapy, and What Can Patients With Cancer Expect?

I don’t know that anyone can say that a certain cancer is their biggest fear, either for themselves or for their children. As a mom, one of the cancers that sticks in the back of my mind most is leukemia. Sadly, we see stories on our social media feeds almost daily of a sweet child battling leukemia. One such child that I have been following, Jacob, lives in the area of Houston that I was raised. As parents – as humans – we want to know what 

 are out there? Is there anything that we can do to lessen our child’s risk of developing this terrible disease? Let’s talk today about 

 and not only its effect on kids, but also the adult population.

By definition, leukemia is a malignancy in the cells that make our blood, which are located in the bone marrow – that spongy material in the center of our bones. From there, the definition branches based on the type of cell that is affected – either myeloid or lymphoid. Myeloid tissues are most known as the blood forming cells in our bone marrow, while lymphoid tissue in the bone marrow is less organized and is related to the immune system. See the image below for an illustration of how these blood cells are born.

Sadly, researchers cannot put an exact finger on what causes leukemia, as opposed to other cancers such as mesotheliomas, or my thyroid cancer that was caused by Hashimoto’s thyroiditis; however, they have been able to nail down some strong correlations.

In several of my previous posts I have talked to you about being careful with correlations, as correlation does not mean causation. I want to tell you how one of my psychology professors explained this. She said that it could be said that a certain number of convicted felons consumed pickles in the year prior to committing the felony. Did the pickle make them commit the felony? Of course not. We can see that we must be very cautious when assigning blame via correlation.

With all that said, the risk factors I describe below have been examined by numerous people in the medical and scientific community. Strong evidence plus correlations does give us some good ideas.

, also known as Trisomy 21 – an extra copy of the 21st chromosome – stand a 2-3% chance of developing either acute lymphocytic leukemia (ALL) or acute myeloid leukemia (AML). Another genetic disorder, known as Li-Fraumeni Syndrome, is associated with an increased risk of leukemia, as well as with other cancers.

Lifestyle related risk factors, such as alcohol use, sun exposure, smoking, and obesity have been linked with an increased risk of leukemia in adults; however, these are not seen in children for some fairly obvious reasons.

Environmental factors have been shown to play a role in the development of leukemias as well. Environmental radiation exposure, as well as previous treatment with chemotherapy and radiation for cancer treatment have been shown to increase the 

 In the case of AML, the American Cancer Society tells us “long-term exposure to benzene is a risk factor for AML. Benzene is a solvent used in the rubber industry, oil refineries, chemical plants, shoe manufacturing, and gasoline-related industries, and is also found in cigarette smoke, gasoline and motor vehicle exhaust, and some glues, cleaning products, detergents, art supplies, and paints.

There have been many factors that have been postulated to increase the risk for leukemia in children, such as work place exposures of the father, the mother’s age, infections, proximity to nuclear power plants, and many others. It is worth noting that none of these have been substantiated in the medical literature.

Just as with genetic factors, there are some 

 over which we have absolutely no control. For example, AML is more prevalent in men and as we age, although doctors are not sure why this is the case.

As always, much love, abundant blessings, and many prayers to all of the cancer warriors and their families. Additional resources can also be obtained by any of the amazing 

https://www.cancer.org/cancer/leukemia-in-children/causes-risks-prevention/risk-factors.html

Is there anything that we can do to lessen our child’s risk of developing this terrible disease? Let’s talk today about leukemia risk factors and its effect on kids

Leukemia Risk Factors

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Bladder Cancer: Overview

Bladder cancer is also known as urothelial carcinoma. Urothelial cells line the urinary tract, including the urethra, bladder, and ureters and renal pelvis in the kidneys. These urothelial or transitional cells are in contact with urine. Bladder cancer happens when those cells in the bladder start to grow out of control.

Smoking and being exposed to secondhand smoke increases the risk of developing bladder cancer. In addition, people exposed to occupational or environmental chemicals may have a higher risk of developing bladder cancer. White people are twice as likely to develop bladder cancer as are Black people or Hispanic people, and older age is another risk factor. Health history also matters, with chronic bladder inflammation, such as urinary tract infections or kidney stones, as well as a personal or family history of bladder cancer, associated with risk of the disease.

Many people are unaware of the common signs of bladder cancer, such as blood in the urine, known as hematuria. If blood in the urine can be seen, this is called gross hematuria. When a physician runs a urinalysis test as part of a routine checkup, tiny amounts of blood may be detected. This is microscopic hematuria. Any blood seen in the urine should be checked by a physician. Irritation when urinating, urgency and frequency are other warning signs. These signs may also be from other causes, such as a urinary tract infection, kidney stones or aging.

Bladder Cancer: Living with Cancer

Bladder cancer has a high rate of recurrence, which implies the need for regular surveillance with cystoscopy over the course of a patient’s lifetime. For some patients, the new normal after bladder removal surgery is adjusting to life with a urinary diversion. A patient should always feel comfortable talking with their health care team about any issues or questions. If the team can’t help, they can usually find someone who can.

Bladder Cancer: Types of Disease

Doctors usually describe and treat bladder cancer by how far it has grown into the bladder wall.

NMIBC (non-muscle invasive bladder cancer) is cancer that remains in the urothelial cells that line the bladder.

MIBC (muscle-invasive bladder cancer) is cancer that has grown into the deeper layers of bladder muscle.

If bladder cancer has spread to other parts of the body outside the urinary tract, it is advanced disease, or metastatic.

Types of bladder cancer include urothelial carcinoma, squamous cell carcinoma, adenocarcinoma, small cell carcinoma and sarcoma.

Urothelial carcinoma, the most common type of bladder cancer, is also known as transitional cell carcinoma. Transitional cell carcinoma begins in the part of the kidney, called the renal pelvis, where urine collects before moving to the bladder.

Squamous cell carcinoma comprises 1% to 2% of bladder cancers, according to the American Cancer Society. Most squamous cell carcinomas of the bladder are invasive.

Adenocarcinoma, which are also mostly invasive, occur in only 1% of bladder cancers.

Small cell carcinoma, which occurs in less than 1% of bladder cancers, start in the neuroendocrine cells. This subtype of the disease can grow quickly.

Sarcoma of the bladder is rare, and start in the muscle cells of the organ.

Bladder Cancer: Diagnosis

A urologist will make a bladder cancer diagnosis. Urologists use a cystoscope to examine the lining of the bladder and the tube that carries urine out of the body (urethra).

If bladder cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has invaded the bladder wall or spread beyond that, and, if so, to what parts of the body. Grade refers to how abnormal the cancer cells look and how many cells are multiplying. A higher grade means the cells are more uneven and are multiplying more. Knowing the grade can help your doctor predict how quickly the cancer will grow and spread.

Bladder Cancer: Treatment

When bladder cancer is classified as NMIBC, surgery to remove the tumor is often the first step. A transurethral resection of the bladder tumor uses a special instrument inserted through the urethra to remove the tumor. If the tumor is low risk/grade and has not invaded the muscle wall of the bladder, it may not require more treatment. Unfortunately, bladder cancer has a high rate of recurrence so most of those who receive diagnoses must return to their urologist at regular intervals for surveillance using cystoscopy to see if the tumors return.

If the tumor cells appear aggressive under the microscope and the pathologist determines that the cancer is high risk/grade, it is more likely to return or worsen. In these cases, further treatment to keep the cancer from returning or worsening is required. Most often, patients with high-grade NMIBC receive intravesical (inside the bladder) treatments. Bacillus Calmette-Guérin (BCG) is an early form of immunotherapy that uses a weakened form of bacteria. When these bacteria are put into the bladder, the immune system goes on alert. It responds by killing cancer cells on the bladder lining. Though BCG is very effective, it doesn’t work for all tumors. If BCG doesn’t work, there are other options such as mitomycin C, an antibiotic that helps fight tumors.

When bladder cancer grows into the deeper layers of the bladder (MIBC), it is more difficult to treat. In many cases, a urologist may suggest radial cystectomy, which is surgery to remove your bladder. Removing the bladder also involves removing lymph nodes around the organ. As part of the surgery, it will be necessary to create a urinary diversion, a new way for urine to leave your body.

Systemic chemotherapy is medicine that treats cancer throughout the whole body. Neoadjuvant chemotherapy is chemotherapy patients get before bladder removal surgery. Clinical trials have shown that cisplatin chemotherapy before bladder removal improves survival for patients with MIBC because it helps kill bladder cancer cells that may be outside the bladder. Adjuvant chemotherapy is the chemotherapy patients get after surgery.

Recently approved targeted therapies can block the growth and spread of cancer. They focus on stopping the cancer-driving activity caused by specific genetic mutations that are found in some bladder cancers.

Some patients may benefit from combined modality therapy, which uses surgery to remove the tumor, plus chemotherapy and radiation to help kill the cancer while keeping the bladder intact. This option can be used for some patients who are ineligible for bladder removal surgery. Those with advanced or metastatic disease may benefit from chemotherapy and a variety of immunotherapies that can help the body fight off the cancer.

There are many talented researchers and clinicians working to improve the diagnosis and treatment of the disease. Clinical trials are an essential part of bladder cancer research. They may provide treatment alternatives to patients who have not had success with standard and approved therapies.

Breast Cancer: Living with Cancer

Similar to other cancers, there is often a fear breast cancer will return, and in some individuals, the cancer will never go away completely. Therefore, it is key to maintain follow-up appointments for physicians to watch closely. These include consistent doctor appointments, mammograms, pelvic exams, bone density tests, as well as we blood and imaging tests.

Survivorship care plans, comprised of a suggested schedule for follow-ups, a list of long-term effects, lifestyle modification suggestions and a summary of ones diagnosis, may be very helpful for long-term care and to aid individuals in transitioning back to a primary care provider.

Breast Cancer: Types of Disease

The type of breast cancer that is diagnosed is determined by specific cells.

Ductal carcinoma in situ, or DCIS, also known as intraductal carcinoma, is when the abnormal cells have not spread through the ducts into surrounding breast tissue. It is a non-invasive breast cancer that has not spread outside of the breast; however, it can become invasive.

Lobular carcinoma in situ, also called lobular neoplasia, is when the abnormal cell growth starts in the lobules of the breast and has likely not spread to surrounding tissues. This subtype can be an indicator for the likeliness of developing invasive cancer in either breast.

Invasive ductal carcinoma, also known as infiltrating ductal carcinoma, is the most common type of breast cancer that occurs when the cancer starts in the ducts of the breast, then grows into fatty breast tissue. This type of breast cancer may spread to other parts of the body.

Invasive lobular carcinoma, also known as infiltrating lobular carcinoma, starts in the lobules of the breast. As one of the less common types, invasive lobular carcinoma may be difficult to detect via mammogram.

Inflammatory breast cancer, an uncommon type of invasive breast cancer, occurs when the cancer cells block the lymph vessels in the skin, causing inflammation, redness, pitted appearance, itchiness or tenderness. In this instance, a lump may not be detected

Paget disease, also rare, starts in the ducts and spreads to the skin of the nipple. Symptoms include crusted, scaly, red, bleeding, oozing, burning or itchy nipples.

Lastly, there are subtypes of breast cancer driven by hormones that will drive treatment decisions: hormone receptor-positive, HER2-positive and triple-negative breast cancer.

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