Karen Loftus (Host): This is Community Connect, presented by Tampa General Hospital. I'm Karen Loftus. Joining me is Dr. Ankit Kansagra, Vice President of Oncology Strategy and Network Operations, and the Medical Director of Bone Marrow Transplant and Cellular Therapy at Tampa General Hospital.

Dr. Kansagra is a triple board-certified hematologist-oncologist and a nationally recognized leader in multiple myeloma, amyloidosis, and cellular therapies. At the TGH Cancer Institute, he offers patients personalized evidence-based care alongside access to advanced cellular and immunotherapies and cutting-edge clinical trials. Welcome to the podcast, Dr. Kansagra.

Ankit Kansagra, MD: Thank you, Karen, for having me here. I look forward to the conversation.

Host: September is Blood Cancer Awareness Month. The three main types of blood cancers that our listeners may have heard of or are familiar with: leukemia, lymphoma, and myeloma. Dr. Kansagra, can you start by giving us an overview of these blood cancers and how they may differ from other types of cancers?

Ankit Kansagra, MD: Great question and a perfect place to start, Karen. You know, most folks know cancer as some common ones like lung cancer, breast cancer, colon cancer. Now, these are the cancers which I call them lumpy disease, which form lumps within different parts of your body or the organs. This is commonly dealt by either cutting them out or using some sort of a radiation therapy on those lesions, and you take care of them.

Blood cancer, on the other end, it's a problem inside the marrow or the factory where these blood cells are made. This is a cancer which is not something you cut out or you operate and do a surgery on it, but this is a cancer where you target where these blood cells are coming from. And , for example, if I give you your blood bone marrow, which is this mushy material inside the bones. We all have bone marrows, and bone marrow is where? It's the factory of all these blood cells are. This is where all different kind of cells like red cells, white cells, platelets. Those are the most common type of cells which are made. Now, depending on which of these cells become abnormal, the subtype of the cancer can be different.

And if you want to take an example, the white blood cells. Now, white blood cells, if they become abnormal or there is a mutation or an anomaly in the manufacturing process of those white cells, you lead to a problem called leukemia. You know, there is another process in our body called lymphatic system, which I described in a very simple way as kind of the checkpoints along the way in the whole body and the whole system. And what they are is, you know, you have lymph glands in your neck, in your groin, in your throat, in your armpits, and they're kind of like the security checkpoints along the way. So, lymphatic system is the security system in your body, which works along and parallel to the blood systems or the blood vessels. Now, if you have any problem with the security system, you end up with a lymphoma, or it's a type of another blood cancer which we just talked about.

And then, you mentioned the third term, which is, you know, I practice on a day-to-day basis, is called multiple myeloma. That is a problem of a special type of a cell within your bone marrow or the blood called plasma cells. We all remember plasma cells from our plasma TV days, you know, from 20 years ago. These are the cells inside your bone marrow. Their job is to make antibodies. And this is where it becomes abnormal in some subset of patients. And then, it leads to a problem called multiple myeloma.

Host: Okay. That was very concise and very understandable. So, thank you for that. How can someone get blood cancer? Is it hereditary? Are there certain risk factors?

Ankit Kansagra, MD: This is another fantastic question. I see this in clinic a very common question, "How did I get blood cancer?" For majority of the blood cancers, it is not hereditary. We identify situations where there are some risk factors, I would say, in two out of 10 individuals, and those risk factors could be exposure to pesticides or chemicals or fertilizers for a long duration of time or a long time ago.

Now, those are noted to be as a potential factors. But for majority of the patients, it is a problem within the, what I call as this DNA, which is not something you inherit from your parents. But inside each cell, there are building blocks of it, and one of those blocks becomes abnormal. And then, it starts piling up, piling up, and then it leads to a form of a blood cancer.



Host: Okay. Got it. When we're looking at symptoms, a lot of these sound like everyday life. We're talking about tired, rundown, maybe easy bruising. I know that I have checked all of those boxes on more than one occasion, right? How does someone know when it's time to meet with their doctor?



Ankit Kansagra, MD: First of all, you are 100% correct. I mean, who is not tired at the end of the day? We all get fatigued and exhausted, right? Any symptom. So, the first important part, I'll tell you three things. The first important piece is any symptom which persist is important, right? So, you have an ongoing and worsening fatigue over days, into weeks, that's something you want to get checked out. We all get a bruise when we bang our knee somewhere or playing a sport. That's okay. That's a normal process of healing. But if you start having bruises, which doesn't go up and bruises after bruises, that's something that's an issue, right? So, remember, a persistence of some symptom is something where you want to call up your primary care doctor and say what it is.

Now, the second part to this, the best part about checking blood cancers or evaluating for them, it's a blood test. And it's as simple as that, your primary care doctor can just—I mean, he or she might already be ordering blood test on a frequent enough basis. You know, things can happen in between those two tests, like you your yearly checkup, you know, in 2025, and now it's 2026. Things can happen differently. So, just have them call your PCP up, and they will draw a blood test, and that could give you an initial kind of signs of what to look for.

Now, once they identify and they say, "Hey," you know, a lot of times it'll be, "Dr. Kansagra said, 'Well, you know, this is a one-time snapshot.'" I tell everybody that one time doesn't tell you a whole story. It's kind of like you take a picture. A picture tells you what is happening at that second. A movie is where you have multiple time points of something. And so, a lot of times, you know, this is what happens in the clinic. I say, "Hey, you know, I saw you on here 30th of August. I'm going to check back with you in two months, three months, see what these blood tests are looking like, and get a snapshot." So, that's your second most important piece.

And the third most important piece to all these things is once these tests are done, there could be more tests your doctors can do, scans or biopsies and things like that. But that usually doesn't happen until the first two things are evaluated.

Host: Okay, that makes sense. Now, that leads perfectly into the next portion of what I want to talk about is this diagnosis piece. You talk about you got to get the blood work done and and get it done to a point where it's alarming enough to maybe do more follow-up tests. Can you walk us through what typically happens next if there are abnormal results from a blood test? What are we talking about as far as follow-up tests and maybe who's on the care team going forward?

Ankit Kansagra, MD: I think this is very important, especially when the patients come into, say, our TGH Cancer Institute to get an evaluation, right? So, once a primary care doctor or any of your team members within your other, it could be all other subspecialists. You went to a gastroenterologist, and he did a CBC. The point is, once you come into our program, we will get a thorough evaluation. Now, that could include tests like a bone marrow biopsy. Now, bone marrow biopsy is done mostly as an outpatient procedure. It's a 10, 15-minute procedure under local anesthetics given at the site of the bone marrow injection. You know, if you get it done, that helps us look inside the factory. We talked about two questions ago where these problems start, and they start inside the factory, so you want to look at that.

The second thing we look at is the lymphatic system. How do you look at the lymphatic system or the checkpoints along your body we just talked about, right? You check them by use different scans, CT scan. There's a special type of scan called a PET scan. You know, those are different modalities which our oncologist will work on ordering those tests to kind of get a good sense on what it is.

Now, I also tell folks is we are moving in the era of personalized and genomic medicine. There's no more these days that, hey, one treatment applies to 10 cancers, right? And so, within these tests, within your blood and the bone marrow, majority of the time here at Tampa General Hospital Cancer Institute, we will check for different genetic markers. What is the abnormality in the tumor-specific cells or the cancer cells itself, and that is the one which is going to help us decide how we can define and design the treatment which fits your needs.

Now, some of these can take two or three or four weeks, but it's okay. Your oncologist will walk you through that process and that guidance and give you what things to do when you're back home. But it's important for folks to understand that once you come into the cancer program or the cancer center for evaluation, there are multiple steps, including tests, biopsies, and way we identify different mutations or problems within the cancer so we can offer you a personalized treatment.



Host: One of the most fascinating things about the advances in healthcare is the technology that you just outlined. And so, that's tied to the treatment piece as you're talking about the specifics and making sure you get the exact treatment for each patient. And I'm sure there's been dramatic changes in the last decade. What are some therapies that are available to patients now that were not even in the discussion 10 years ago?

Ankit Kansagra, MD: Now, this is the most exciting part of my conversation with the patient, right? When a patient sits down with me in front of it, they're obviously scared and afraid of what is happening to them, and a lot of my conversation goes around where the progress has happened. I've been doing this for two decades in the field of oncology, and I can tell you, I'll give you examples of few therapies, and it will give you a sense of where we have advanced.

One of the very innovative forms of immunotherapy, which we call as CAR T-cell therapy, you know, which is a type of a cellular therapy. And what we do, the biggest problem in a blood cancer is your own immune cells or your own fighting cells are not able to identify the cancer cells and kill them. So cancer cells are smart in terms of hiding itself from your, kind of your fighting cells or your police cells, what we call this, right? Mm-hmm. So what we need to do?

Well, there are a couple ways we can do that. One thing is we take those immune cells out of your body, kind of like people have given blood donation. And you know, it's a very similar way we take the blood or specific type of T cells outside your body, and we engineer them.

Now, this is where fascinating part starts. What do we do is we take these immune cells. And first of all, I tell them, we give them binoculars so that they can go back inside and look and identify the cancer cells exactly where they are. And then the second thing, while we give them binoculars, we do the second thing, is we give them ammunition so that they can go back in and kill those cancer cells.

Now, the third most fascinating thing we do with this is we give them a multiplying power. So if we take out a million cells, we change it into 300 million cells and infuse it back to them. So now, you could imagine how personalized therapy it is. It's personalized to you, personalized to the type of the cancer you have, and personalized to the where your cancer is at particular stage of the treatment.

So, this is fascinating, and this is all within the last five to 10 years these treatments have been started. And this is where a lot of fascinating advances in treatments we offer here at Tampa General Cancer Institute.

Host: This sounds very encouraging. All right, as we wrap up this conversation here, you have two decades in this field. What makes you most hopeful right now? I know we've touched on some of this and the advances and stuff, but maybe more specifically, what makes you most hopeful regarding the future of treatment?

Ankit Kansagra, MD: I'll leave with two thoughts, Karen, in these. I think the first part is the advances in the field are just so tremendously quick and fast. The cancers we would used to have, I've given examples, leukemia about few decades back, you know, about one in four individuals will die within five years of their diagnosis.

Fast-forward to today, three in four individuals will do fantastic. They won't even have any issues at the end of five years of their follow-up and evaluation. So, we have significantly improved, and we can start picking each cancer by itself. You know, mortality has improved significantly. And I think the advances in way we deliver these therapies and the new science has gone is amazing and fascinating, right?

And then, the second piece to part of this is exactly these conversations. I see these conversations where we are educating the community. What I foresee is kind of like identifying the flame before the fire goes. What we call as inception means identifying the cancer before it is too far out and cutting its head off before it can cause to be a cancer. Identifying in the precancerous stage. And we are going in many cancers that we don't even want it to be a cancer, be in a precancerous stage and completely get it done ahead of time. And so, I think that is the fascinating piece I hope to see in the next decade to come.

Host: Incredible. I can hear the enthusiasm in your voice about this.

Ankit Kansagra, MD: Thank you.

Host: Well, Dr. Kansagra, thank you so much for being on our podcast and just sharing your wealth of information on this topic.

Ankit Kansagra, MD: Thank you for having me. Very nice conversation too. That has been Dr. Ankit Kansagra.

Host: For more information, please visit tgh.org/hematology. If you enjoyed this episode, please be sure to like, subscribe and follow Community Connect presented by TGH on your favorite podcast platform. I'm Karen Loftus, and this is Community Connect presented by TGH. Thanks for listening.

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