UVA Cancer Center has a team of dedicated physicians who specialize in the diagnosis and treatment of non-cancerous (benign) blood disorders, including those that are secondary to hematologic or other cancers. Our hematopathologists are experts in identifying rare and complex diseases of the blood, and our benign hematology physicians and nurses offer superior care for patients in whom blood disorders have been diagnosed.
Dramatic advances have been made in recent years for most hematological cancers because of research. Novel targeted therapies, which complement or replace traditional chemotherapy and radiation treatments, are now routine for many hematological malignancies.
Listen as Karen Ballen, MD discusses Hematologic malignancies and stem cell transplantation at The UVA Cancer Center.
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Hematologic Malignancies and Stem Cell Transplantation
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Learn more about Karen K. Ballen, MD
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Karen K. Ballen, MD
Karen K. Ballen, MD is the Director of Stem Cell Transplantation at UVA Cancer Center and Professor of Medicine at UVA School of Medicine.Learn more about Karen K. Ballen, MD
Learn more about UVA Cancer Center
Transcription:
Hematologic Malignancies and Stem Cell Transplantation
Melanie Cole (Host): UVA Cancer Center has a team of dedicated physicians who specialize in the diagnosis and treatment of blood disorders. The hematology physicians and nurses offer superior care for patients in whom blood disorders have been diagnosed. My guest today is Dr. Karen Ballen. She's the Director of Stem Cell Transplantation and Hematologic Malignancies at UVA Cancer Center. Welcome to the show, Dr. Ballen. So, what conditions would be associated with hematologic malignancies? Explain what that is to the listeners.
Dr. Karen Ballen (Guest): Well, thank you so much for having me on. My mother asked me the same question. So, hematologic malignancies refer to cancers of the blood and most of patients that we see have either leukemia, a type of blood cancer, lymphoma, Hodgkin's Disease, or multiple myeloma. It would also encompass patients who have what we call “myo-proliferative diseases”. Some of those are diseases such as chronic myeloid leukemia or myelofibrosis. So, these are all cancers of the blood.
Melanie: First of all, who's at risk for blood type cancers?
Dr. Ballen: Well, unfortunately, we all are at risk, and as we get older, the risk of having a blood cancer goes up. Blood cancers aren't necessarily related to any lifestyle choices such as smoking or alcohol or where you live. We are still really learning about why people get them. So, we actually all are at risk for developing a blood cancer.
Melanie: Are there any genetic components to them?
Dr. Ballen: There are genetic components in that there are different genetic mutations that can contribute to blood cancers, but most of these are not passed down in families.
Melanie: So, what symptoms would somebody experience that would send them to somebody to get checked in the first place?
Dr. Ballen: Well, you know, often the symptoms are very mild. It might be fatigue or a headache, or sometimes easy bruising, and sometimes it is difficult. Some patients do see several doctors or maybe have gone to the emergency room before the diagnosis is made, but certainly, a fatigue that seems out of proportion to what one usually has, easy bruising, fevers and infections that don't go away would all be signs that people should get blood counts checked and get further care to make sure that there's no problem.
Melanie: So, if you do the blood counts and you diagnose with lymphoma or Non-Hodgkin's, or one of these things you've mentioned, what is the next step for that person?
Dr. Ballen: Right. So, these diseases are usually diagnosed either on a bone marrow test or on a biopsy of a lymph node, and then once a diagnosis is made, we'll evaluate the patient here at UVA and often, will work with our colleagues in other specialties such as radiation, or surgery, to give the patient the best care possible. Fortunately, most of these diseases are curable and patients will then start on a treatment plan often involving chemotherapy. The good news is that our chemotherapy these days is a lot easier to take. We have many medicines for nausea to make patients more comfortable. So, in many cases, we will have an excellent outcome.
Melanie: You mentioned radiation. Can you use radiation therapies for blood cancers when blood is moving and it's not in a specific spot?
Dr. Ballen: Well, that's a great question. So, for some of the blood cancers like leukemia, we don't usually use radiation, but for others such as lymphoma, or Hodgkin's disease, particularly if the disease is localized in a specific spot, then sometimes radiation can be very successful and sometimes it's given by itself, or maybe in combination or after chemotherapy.
Melanie: So, Dr. Ballen, speak about stem cell transplantation and how that works. Give the listener a little working definition of what that is and hematopoietic cell transplantation.
Dr. Ballen: Right. So, we all have stem cells in our bodies. These are the cells that make all of our blood cells. Our red cells that carry oxygen and white cells that fight infection and platelets that help to clot the blood. When someone has a stem cell or bone marrow or hematopoietic cell transplant, we're all talking about the same thing. It's basically taking someone who has a bone marrow disease and replacing their abnormal bone marrow with a normal bone marrow from a donor. That donor could be a brother or sister. Nowadays almost everyone has a donor, either in their family, through the only related registry, or through something through what we call umbilical cord blood. Blood that normally just gets thrown out when a woman has a baby, can also be used to save someone's life in a transplant.
Melanie: How does that work, then, and then just explain a little bit for the listeners about transplant related morbidity and what they can expect as far as rejection of the marrow or the stem cells? How does that all work?
Dr. Ballen: Right. Well, for the donor, the donor usually has the easy part. The donation is usually done as an outpatient and usually takes several hours. For the patient, it is a long process. The patient may be hospitalized for several weeks here at UVA. During that time, they're receiving intensive chemotherapy and what we call supportive care--antibiotics and transfusions and medicines to make them feel more comfortable. So, it is an intensive procedure but, fortunately, it's something that we're getting better and better at and making it safer and easier for the patient to get through.
Melanie: You mentioned that some of these are curable. What does that mean for the patient and how do you know?
Dr. Ballen: Right. So, when we say curable, it means that the patient has no evidence of their disease and often, you know, to be honest, that means that they're living 15, 20, or 25 years later and maybe getting hit by a bus or some other event happens but unrelated to the cancer. So, for many of these cancers, if the disease has not come back in a five-year interval, it's very unlikely that it would and so that's also an important landmark in many of these diseases.
Melanie: Are there any current clinical trials at UVA?
Dr. Ballen: Yes. So, we have many clinical trials at UVA. Some of them relate to choosing the best donor for a patient who is undergoing a stem cell transplant, that's a very large, national study. We're also looking at using different types of chemotherapy and immunotherapy to help fight cancers. That's a new way of treating blood cancers by using the immune system to help fight the cancer. That's the focus of many of our clinical trials at UVA.
Melanie: Dr. Ballen, if somebody is interested in being a bone marrow or stem cell donor, what should they know? What do you want them to do?
Dr. Ballen: Well, the best way to find information is through the international registry which is called “Be the Match” and they can find that information online. And to become a donor, all it takes nowadays is just a cheek swab that puts the DNA sample into the registry.
Melanie: So, tell us about your team at the UVA Stem Cell Transplant program.
Dr. Ballen: Right. So, we have an excellent team. It certainly does take a village to care for these patients in the best manner possible and we're fortunate to have an excellent team of physicians, nurses, coordinators, physical therapists, dieticians, social workers all really working to help in the care of the patient. It's the people sometimes they don't see who are most important for their care, that includes everyone that keeps the hospital running from an administrative and facilities standpoint; it's the people in pathology reading the slides; people reading their X-rays, that often also have a big impact on a successful outcome.
Melanie: So, wrap it up for us, if you would, Dr. Ballen, with your best advice for people that are concerned about blood cancers and what you want them to know about the UVA Cancer Center.
Dr. Ballen: Yes. Well, I think unfortunately cancer affects all of us. We've almost all had a friend or family member that's affected by cancers. I think the good news is that the majority of these patients are curable, while the treatment is not easy, it is often successful and, therefore, patients should be hopeful and we're certainly happy to work with the patient on their journey through this.
Melanie: Thank you so much for being with us. It's really great information. You're listening to UVA Health Systems Radio and for more information, you can go to www.uvahealth.com. That's www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.
Hematologic Malignancies and Stem Cell Transplantation
Melanie Cole (Host): UVA Cancer Center has a team of dedicated physicians who specialize in the diagnosis and treatment of blood disorders. The hematology physicians and nurses offer superior care for patients in whom blood disorders have been diagnosed. My guest today is Dr. Karen Ballen. She's the Director of Stem Cell Transplantation and Hematologic Malignancies at UVA Cancer Center. Welcome to the show, Dr. Ballen. So, what conditions would be associated with hematologic malignancies? Explain what that is to the listeners.
Dr. Karen Ballen (Guest): Well, thank you so much for having me on. My mother asked me the same question. So, hematologic malignancies refer to cancers of the blood and most of patients that we see have either leukemia, a type of blood cancer, lymphoma, Hodgkin's Disease, or multiple myeloma. It would also encompass patients who have what we call “myo-proliferative diseases”. Some of those are diseases such as chronic myeloid leukemia or myelofibrosis. So, these are all cancers of the blood.
Melanie: First of all, who's at risk for blood type cancers?
Dr. Ballen: Well, unfortunately, we all are at risk, and as we get older, the risk of having a blood cancer goes up. Blood cancers aren't necessarily related to any lifestyle choices such as smoking or alcohol or where you live. We are still really learning about why people get them. So, we actually all are at risk for developing a blood cancer.
Melanie: Are there any genetic components to them?
Dr. Ballen: There are genetic components in that there are different genetic mutations that can contribute to blood cancers, but most of these are not passed down in families.
Melanie: So, what symptoms would somebody experience that would send them to somebody to get checked in the first place?
Dr. Ballen: Well, you know, often the symptoms are very mild. It might be fatigue or a headache, or sometimes easy bruising, and sometimes it is difficult. Some patients do see several doctors or maybe have gone to the emergency room before the diagnosis is made, but certainly, a fatigue that seems out of proportion to what one usually has, easy bruising, fevers and infections that don't go away would all be signs that people should get blood counts checked and get further care to make sure that there's no problem.
Melanie: So, if you do the blood counts and you diagnose with lymphoma or Non-Hodgkin's, or one of these things you've mentioned, what is the next step for that person?
Dr. Ballen: Right. So, these diseases are usually diagnosed either on a bone marrow test or on a biopsy of a lymph node, and then once a diagnosis is made, we'll evaluate the patient here at UVA and often, will work with our colleagues in other specialties such as radiation, or surgery, to give the patient the best care possible. Fortunately, most of these diseases are curable and patients will then start on a treatment plan often involving chemotherapy. The good news is that our chemotherapy these days is a lot easier to take. We have many medicines for nausea to make patients more comfortable. So, in many cases, we will have an excellent outcome.
Melanie: You mentioned radiation. Can you use radiation therapies for blood cancers when blood is moving and it's not in a specific spot?
Dr. Ballen: Well, that's a great question. So, for some of the blood cancers like leukemia, we don't usually use radiation, but for others such as lymphoma, or Hodgkin's disease, particularly if the disease is localized in a specific spot, then sometimes radiation can be very successful and sometimes it's given by itself, or maybe in combination or after chemotherapy.
Melanie: So, Dr. Ballen, speak about stem cell transplantation and how that works. Give the listener a little working definition of what that is and hematopoietic cell transplantation.
Dr. Ballen: Right. So, we all have stem cells in our bodies. These are the cells that make all of our blood cells. Our red cells that carry oxygen and white cells that fight infection and platelets that help to clot the blood. When someone has a stem cell or bone marrow or hematopoietic cell transplant, we're all talking about the same thing. It's basically taking someone who has a bone marrow disease and replacing their abnormal bone marrow with a normal bone marrow from a donor. That donor could be a brother or sister. Nowadays almost everyone has a donor, either in their family, through the only related registry, or through something through what we call umbilical cord blood. Blood that normally just gets thrown out when a woman has a baby, can also be used to save someone's life in a transplant.
Melanie: How does that work, then, and then just explain a little bit for the listeners about transplant related morbidity and what they can expect as far as rejection of the marrow or the stem cells? How does that all work?
Dr. Ballen: Right. Well, for the donor, the donor usually has the easy part. The donation is usually done as an outpatient and usually takes several hours. For the patient, it is a long process. The patient may be hospitalized for several weeks here at UVA. During that time, they're receiving intensive chemotherapy and what we call supportive care--antibiotics and transfusions and medicines to make them feel more comfortable. So, it is an intensive procedure but, fortunately, it's something that we're getting better and better at and making it safer and easier for the patient to get through.
Melanie: You mentioned that some of these are curable. What does that mean for the patient and how do you know?
Dr. Ballen: Right. So, when we say curable, it means that the patient has no evidence of their disease and often, you know, to be honest, that means that they're living 15, 20, or 25 years later and maybe getting hit by a bus or some other event happens but unrelated to the cancer. So, for many of these cancers, if the disease has not come back in a five-year interval, it's very unlikely that it would and so that's also an important landmark in many of these diseases.
Melanie: Are there any current clinical trials at UVA?
Dr. Ballen: Yes. So, we have many clinical trials at UVA. Some of them relate to choosing the best donor for a patient who is undergoing a stem cell transplant, that's a very large, national study. We're also looking at using different types of chemotherapy and immunotherapy to help fight cancers. That's a new way of treating blood cancers by using the immune system to help fight the cancer. That's the focus of many of our clinical trials at UVA.
Melanie: Dr. Ballen, if somebody is interested in being a bone marrow or stem cell donor, what should they know? What do you want them to do?
Dr. Ballen: Well, the best way to find information is through the international registry which is called “Be the Match” and they can find that information online. And to become a donor, all it takes nowadays is just a cheek swab that puts the DNA sample into the registry.
Melanie: So, tell us about your team at the UVA Stem Cell Transplant program.
Dr. Ballen: Right. So, we have an excellent team. It certainly does take a village to care for these patients in the best manner possible and we're fortunate to have an excellent team of physicians, nurses, coordinators, physical therapists, dieticians, social workers all really working to help in the care of the patient. It's the people sometimes they don't see who are most important for their care, that includes everyone that keeps the hospital running from an administrative and facilities standpoint; it's the people in pathology reading the slides; people reading their X-rays, that often also have a big impact on a successful outcome.
Melanie: So, wrap it up for us, if you would, Dr. Ballen, with your best advice for people that are concerned about blood cancers and what you want them to know about the UVA Cancer Center.
Dr. Ballen: Yes. Well, I think unfortunately cancer affects all of us. We've almost all had a friend or family member that's affected by cancers. I think the good news is that the majority of these patients are curable, while the treatment is not easy, it is often successful and, therefore, patients should be hopeful and we're certainly happy to work with the patient on their journey through this.
Melanie: Thank you so much for being with us. It's really great information. You're listening to UVA Health Systems Radio and for more information, you can go to www.uvahealth.com. That's www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.