Blood and bone-marrow cancers

What are cancers of the blood?

The blood is made up of various constituents.

Cells:

• Red blood cells, which transport oxygen.
• Platelets, which help blood to coagulate.
• Leukocytes or white blood cells, which are involved in defense against infections and are broken down into several families: polynuclear, lymphocytes/plasmocytes, which produce antibodies, and monocytes.

Plasma, a liquid which contains various proteins and blood cells.

The blood cells are created, renew themselves and develop in the bone marrow, and then pass into the blood and/or lymphatic system and the lymph nodes.
Hematology is a medical specialty involved in all diseases affecting the blood cells, whether they are benign (anaemia, for example) or malignant. Onco-hematology deals with all forms of cancer affecting the blood cells.

There are different “families” of blood cancers which present, evolve and are treated in a specific way.

Leukaemias, characterized by the abnormal presence of cells in the blood: they may be acute, if they evolve rapidly, or chronic, generally evolving slowly. These diseases first develop in the bone marrow and the blood and may then invade many organs (in particular the lymph nodes, liver and spleen).

Lymphomas are characterized by the proliferation of lymphocytes, which develop in the lymph nodes, liver, spleen and, more rarely, in other organs, and cause them to increase in size (adenopathies, hepatomegaly, splenomegaly). Two kinds of lymphomas have been distinguished: Hodgkin’s lymphomas and non-Hodgkins lymphomas. Non-Hodgkins lymphomas are the most common; they may be aggressive or indolent (slow-growing). They represent the fifth-largest cause of cancer in France.

Myelomas are due to the proliferation of the most “mature” forms of lymphocytes, which are also called plasmocytes and whose physiological role is to secrete antibodies. During myeloma, the abnormal plasmocytes produce, in excessive quantities, a certain antibody (called monoclonal peak) as well as other substances that may lead to bone destruction and renal lesions.

As the case may be, the diagnosis will be based on a blood and bone marrow test carried out after the first consultation (leukemia and myeloma), or on a ganglion biopsy performed by our surgeons (lymphomas). An extended assessment of the disease will be made involving scans and PET scans in addition to the tests already mentioned.

Each type of blood cancer calls for specific treatments using very different drugs, depending on the major categories described above.

 

Care management at Institut Curie

Patients with cancers of the blood can be treated at one of two Institut Curie sites, depending on geographic origin: in Paris, or in Saint-Cloud.

Multidisciplinary healthcare is systematically set up to offer patients the most appropriate treatment. Each case is discussed at a multidisciplinary consultation meeting (RCP), which includes the biologists who have examined the samples (marrow, blood and lymph nodes), radiologists and hematologists.

This treatment will follow national or international recommendations, if these are clearly defined for the disease to be treated and depending on its stage of development. At present however, the treatment of hematological diseases is increasingly personalized, geared to targeted therapies already marketed or awaiting marketing authorization. In these cases, the treatment will be adapted to the most recent medical knowledge, taking into account the publications already validated, the specificities of each person and the biological characteristics of the disease.

Over the past 10 years or so, the Hematology department of Institut Curie has developed expertise in the treatment of lymphomas of the central nervous system and the eye by implementing special protocols adapted to these very specific locations of the disease. Several protocols have been developed on a national scale, at the initiative of Dr Carole Soussain. Institut Curie is recognized as a benchmark center for this rare disease. An RCP to discuss treatment for these rare tumors takes place every two weeks under the aegis of the LOC network, approved by INCa in 2013, with double coordination (Neurology/Hôpital Pitié-Salpêtrière, Hematology/Institut Curie).

Institut Curie participates actively in numerous cooperative groups involved in the care and development of treatments for hematological diseases (LYSA, ALFA, IFM, FIM, PhiLMC, GFM).

 

Our research

Institut Curie’s Hematology department actively participates in the protocols. Their purpose is to improve knowledge and treatment of haematological diseases. They have been validated by an ethics committee and l’Agence nationale de sécurité sanitaire, as well as by a patients’ committee. They are offered to the patient, who can choose between benefiting from them or being cared for according to the most recently validated reference treatment.

Hematologists and researchers work together to better understand the mechanism and the origin of blood cancers and to discover the cells involved in their development.