Blood cancer: Risk factors, symptoms, treatments, and questions to ask your doctor

Blood cancers are among the top 10 most commonly diagnosed type of cancer in the U.S. In 2023, an estimated combined total of 184,720 people were expected to be diagnosed with this type of cancer, which is approximately 9.4% of the total new cancer cases for that year in the U.S.

Blood cancer is a group of five diseases:

• Leukemia
• Lymphoma
• Myeloma
• Myelodysplastic syndromes (a group of cancers where immature blood cells in bone marrow do not mature and become healthy cells)
• Myeloproliferative neoplasms (a group of cancers where the bone marrow makes too many red or white blood cells or platelets)

Lymphoma, leukemia, and myeloma are the most common types of blood cancers.

• Lymphoma forms in the body’s lymphatic system. Abnormal lymphocytes (a type of infection-fighting white blood cell) become lymphoma cells. These cells multiply and collect in the lymph nodes and other tissue, impairing the immune system. The two main subtypes of lymphoma are Hodgkin’s lymphoma and non-Hodgkin’s lymphoma.
• Leukemia affects both the bone marrow and blood. The disease causes the body to produce abnormal white blood cells that are not able to fight infection, the normal role of white blood cells in the immune system. It also impairs the bone marrow’s ability to produce red blood cells and platelets. Leukemia is classified by how quickly it progresses and which cells it affects.

Acute leukemia is the more aggressive form of the disease and progresses more quickly. Chronic leukemia affects mature blood cells, which can often function normally for an extended period of time. The abnormal cells replicate slowly and may not cause any symptoms during the early stages of the disease.

Leukemia is also classified by whether it affects the lymphocytes, which form the tissue that makes up the immune system, or the myeloid cells, which produce red and white blood cells and platelet-producing cells. The major types of leukemia include:

• Acute lymphocytic leukemia (the most common leukemia in children)
• Acute myelogenous leukemia (the most common leukemia in adults)
• Chronic lymphocytic leukemia
• Chronic myelogenous leukemia
• Myeloma, also called multiple myeloma, affects plasma cells, weakening the immune system and causing cancerous plasma cells to accumulate in the bone marrow.

What factors increase blood cancer risk?

There are a number of factors associated with an increased risk of developing leukemia as an adult. These include:

• Previously undergoing radiation and/or chemotherapy to treat another cancer
• Genetic disorders, including Down syndrome and Li-Fraumeni syndrome, a genetic disorder that increases the risk of developing a wide range of cancers during your lifetime
• Benzene exposure
• Smoking
• Family history of leukemia

Factors that are associated with an increased risk of lymphoma in adults include:

• Being older than 55
• Being male
• Having an immune disorder or an immune system suppressed by medication
• Epstein-Barr virus and helicobacter pylori infection, a bacteria that infects the stomach and small intestine

Blood cancer symptoms

Each type of blood cancer can cause different symptoms, but there are some symptoms that these types of cancer share, including:

• Frequent infections
• Unexplained fever and/or chills
• Night sweats
• Frequent, unexplained rashes, bruising, or bleeding
• Unexplained weight loss
• Bone and/or joint pain
• Frequent cough
• Chest pain
• Itchy skin
• Loss of appetite and/or nausea
• Shortness of breath
• Headaches
• Swollen, painless lymph nodes in the neck, groin, or armpits
• Weakness and/or ongoing fatigue
• Abdominal discomfort
• Brain fog

Blood cancer in children and teens

Leukemia is the most commonly diagnosed type of cancer in children under the age of 15, making up 28% of childhood cancer diagnoses, while lymphoma is the third most commonly diagnosed cancer in children. For teens, lymphoma is the second most commonly diagnosed cancer and leukemia is the third most common.

In most cases, childhood leukemia is acute, meaning the abnormal cells multiply quickly. Acute lymphocytic leukemia is the most common type, with acute myeloid leukemia making up most of the remaining cases. The definitive cause of childhood leukemia is not known, but there are factors that can increase a child’s risk of developing this type of cancer, including:

• High levels of radiation exposure
• Some inherited syndromes, including Down syndrome and Li-Fraumeni syndrome, a genetic disorder that increases the risk of developing a wide range of cancer during your lifetime
• Inherited immune system conditions, including ataxia-telangiectasia, Wiskott-Aldrich syndrome, Bloom syndrome, and Shwachman-Diamond syndrome
• Having a sibling with leukemia
• Chemotherapy for other cancers
• Suppressed immune system, for example children who’ve had an organ transplant and take immunosuppressant medications to prevent organ rejection

Both Hodgkin and non-Hodgkin lymphoma can be diagnosed in children and teens. Non-Hodgkin lymphoma is more common in younger children while Hodgkin lymphoma is more common in adolescents. There are several subtypes of non-Hodgkin lymphoma, including Burkitt lymphoma, lymphoblastic lymphoma, and large cell lymphoma.

Like leukemia, the underlying cause of childhood lymphoma is not known. There are some factors that are associated with increased risk of developing the disease, including:

• Gender (males have a higher risk)
• Race (Caucasians have a higher risk)
• Epstein-Barr and HIV infection
• Inherited immune system conditions, including ataxia-telangiectasia, Wiskott-Aldrich syndrome, Bloom syndrome, and Shwachman-Diamond syndrome
• Immune system diseases such as lupus and rheumatoid arthritis
• Immune system that’s suppressed with medication
• Having a parent or sibling with lymphoma

Blood cancer treatments

First line treatments for most types of blood cancer include chemotherapy, targeted immunotherapies (drugs that target the changes in cancer cells that help them grow and spread), and monoclonal antibodies (man-made versions of antibodies that attach to a target on cancer cells and destroy those cells). Some people also undergo radiation therapy.

If the cancer does not respond adequately to first line treatments or returns after successful treatment, there are several newer treatment options available, depending on the type of cancer you’ve been diagnosed with. Those options include:

• Stem cell transplantation: Stem cell transplantation replaces damaged stem cells with healthy ones. There are two types of stem cell transplantation used to treat blood cancers—autologous and allogenic.

In autologous stem cell transplantation, the patient takes medications to increase the number of stem cells and cause them to migrate from the bone marrow to the blood stream. Blood is then collected, undergoes apheresis—technology that separates blood into its four components: red blood cells, white blood cells, platelets, and plasma—and is treated with a preservative and frozen. The patient then undergoes intensive chemotherapy. After chemotherapy, the processed stem cells are re-infused into the patient’s bloodstream, where they create new, healthy blood cells.

The other type is allogeneic stem cell transplantation. For this treatment, donated stem cells from a family member or an unrelated donor are gathered, treated, then used for the transplant.

• CAR (chimeric antigen receptor) T-cell therapy: The patients’ own T-cells, which are white blood cells that destroy foreign cells in the bloodstream, are used in this immunotherapy treatment. T-cells are collected from the patient’s blood using apheresis. The cells are then modified in a lab so they attack cancer cells, multiplied, then infused into the patient’s bloodstream, where they remain active for years, working to prevent the return of the cancer.

There are currently six FDA-approved CAR T-cell therapies: YESCARTA®, KYMRIAH®, TECARTUS™, ABECMA®, Breyanzi® and CARVYKTI®. These medications are currently available for certain adults with relapsed/refractory diffuse large B-cell lymphoma (DLBCL); DLBCL arising from follicular lymphoma; relapsed/refractory chronic lymphocytic leukemia; relapsed/refractory small lymphocytic lymphoma; primary mediastinal lymphoma; high-grade B-cell lymphoma; mantle cell lymphoma; follicular lymphoma; relapsed/refractory B-cell acute lymphoblastic leukemia; and multiple myeloma.

CAR T-cell therapy is available to children and adolescents with advanced B cell acute lymphoblastic leukemia and relapsed or refractory large B-cell lymphomas.

• Bispecific antibodies: The FDA has approved several bispecific antibody treatments for blood cancer—teclistamab, elranatamab, and talquetamab-tgvs for multiple myeloma; mosunetuzumab for follicular lymphoma; epcoritamab to treat relapsed or refractory diffuse large B-cell lymphoma; and glofitamab to treat relapsed or refractory diffuse large B-cell lymphoma or large B-cell lymphoma.

These treatments work by attaching to both the surface of cancer cells and T-cells, bringing them together and allowing the T-cells to kill the cancer cells. Several other bispecific antibody treatments for other types of blood cancers are in clinical trials or awaiting FDA approval.

• Menin inhibitors: These drugs, which are still in clinical trials, are a targeted treatment for several forms of acute myeloid leukemia. An early phase clinical trial found that approximately one-third of participants were in complete remission after treatment. Most patients in the trial had leukemia caused by a mutation in the NPM1 gene or an MLL rearrangement, a chromosome abnormality where one piece of a chromosome breaks off and attaches to another chromosome. These changes use menin, a type of protein, to fuel cancer growth. By blocking the menin, the drug in this trial, revumenib, transforms leukemia cells back into normal blood cells.

Questions to ask your physician

Ask your physician these questions if you’re diagnosed with blood cancer.  The more you know and understand about your diagnosis and treatment options, the more informed decision you can make. These questions can help you gather the evidence-based information that will help you make those decisions with greater peace of mind.

• What type of blood cancer have I been diagnosed with?
• What is my prognosis?
• What factors might affect my outcome or prognosis?
• Is this a definitive diagnosis or are more tests needed?
• What are my treatment options? What are the potential advantages, risks, side effects, and late effects of each?
• Which treatment approach do you recommend and why?
• What outcome does this treatment have the potential to achieve—cure, remission, or something else?
• How will treatment affect my ability to work and take part in my daily activities?
• Are there other options if this treatment does not work or stops working?
• Where is the best place for me to receive treatment and what types of specialists do I need?
• Are there clinical trials available to me and should I consider one?
• What support services are available during and after treatment?
• How will we know if the treatment is working?
• What are some strategies to manage side effects?

Get support from a PinnacleCare Health Advisor

Connect with a PinnacleCare Relationship Manager today to learn how a personal Health Advisor can support you through a cancer diagnosis—getting you the right care for your situation from leading blood cancer specialists—or support you with any of your health needs.