Hematologic neoplasms are highly curable depending upon stage at diagnosis and the degree of pre-treatment disease. Hematological malignancies are better treated than their benign counterparts in most cases.
Hematologic neoplasms are most probably due to a multifactorial combination of environmental, immunological, genetic and other causative factors. However, hematological neoplasms have common features that can help in the clinical diagnosis and in understanding their pathogenesis.
Chemotherapy and radiotherapy are the treatments of choice for almost all forms of cancer; both are used for more aggressive and advanced disease. The chemotherapy regimen may change over time as newer agents of induction and/or consolidation are developed and implemented, as demonstrated in the treatments discussed below. New approaches to chemotherapy in leukemia and lymphoma remain under investigation.
A small but measurable number of people in the United States, around 8 in 100,000, receive hematologic neoplasms a year. Of particular relevance, 1 in 3 men are carriers of a genetic predisposition to develop these malignancies. Most common of these are B-cell lymphomas, mainly leukemia and multiple myeloma, and, to a lesser extent, Hodgkin's disease and non-Hodgkin's lymphoma.
Symptoms of leukemias and lymphomas are usually nonspecific. In contrast with solid tumors, symptoms from hematologic neoplasms are not typically alarming in an unselected patient population. Although patients with myeloproliferative neoplasms and lymphomas are prone to increased discomfort resulting from the growth of the neoplasm, other signs are more often present when the disorder is in their early phases. Hemoglobin and erythropoietin levels are often elevated as a result of hemoglobin synthesis.
Hematologic neoplasms occur from the abnormal growth of blood or bone marrow cells. Hematologic neoplasms are grouped under several histologic types and include leukemia, lymphoma, multiple myeloma and multiple bone tumors. Cancer is often difficult to recognize early. Most patients with the disease have either poor or no control of the disease at the time of diagnosis or before referral. About one third of patients will die from the disease within two years of diagnosis. The best overall outcome is for acute lymphoblastic leukemia when it was definitively diagnosed, whereas most patients will die when their disease becomes unrecognized and undiagnosed.
These studies demonstrate that both patients undergoing RT and patients with the LFSR are at risk for developing a cancer of the blood or blood-forming system.
Most adults with advanced neoplasia will require a clinical trial. The need for a clinical trial is most commonly for patients whose disease has progressed following standard therapy.
Patients treated with chemotherapy for myeloma may experience a variety of side effects. These side effects are not necessarily necessarily a reflection of the underlying cause or a surrogate marker for disease progression. The most common side effects of chemotherapy reported in this population are febrile neutropenia, peripheral neuropathy, anemia, and pulmonary toxicity. Symptoms usually manifest within 3 to 12 weeks after commencing chemotherapy. The development of aseptic meningitis is a common complication of high doses of cisplatin. In the current study, the incidence of aseptic meningitis in patients receiving cisplatin was 0% (6/637). The most common side effect of thalidomide treatment is peripheral neuropathy.
The treatment of choice is often determined by factors such as the risk to the patient, the risk to the clinician with respect to malpractice suits, and the cost-benefit of the treatment. For example, if there are concerns about the risk of life-threatening bleeding, then therapies that involve the risk of this are not recommended.
In recent years, the researchers are increasingly more concerned about the epigenetic modification of tumor cells, which, in conjunction with the existing mutations, causes tumor cell proliferation, growth, and the development of metastases. Many authors insist on the necessity of the epigenetic modification and metastasis of tumor in the treatment of disease and prevention of metastasis. The combination of these two characteristics is most significant to understand the progress of the disease pathogenesis, metastasis, and treatment by the use of medications. Recent findings have become more and more remarkable and promising research for hematologic neoplasms. A wide variety of drugs is prescribed to control the disease and to prevent tumors development and metastasis.
The major risk factor for these two types of malignancies is occupational exposure to ionizing radiation, particularly nuclear fallout during nuclear weapons testing. The relative risk of leukemia is high and is the highest between 1 and 10 Bq/m. The most common type of leukemia associated with ionizing radiation exposure is chronic myeloid leukemia and the second is acute lymphoblastic leukemia. Exposure to low doses of radiation below 5 mR or low doses of radiation plus a weak and transient exposure to high doses appears not to increase the risk.