Blood (Hematologic) Malignancies

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton  

Introduction

Hematologic malignancies impact the normal production and function of blood cells, starting commonly in bone marrow, the site were stem cells develop into white blood cells, red blood cells, or platelets. These cancers happen when an unchecked growth of abnormal cells overtakes the development of normal blood cells, interrupting with the regular functions of those cells.

Epidemiology

Hematologic malignancies are among the most common cancers globally, annually, an estimated 1187000 new patients worldwide are diagnosed with haematological malignancies, including leukaemia, myeloma, and lymphoma, resulting in 690000 deaths. Incidence increases with age, reaching a maximum at 75–99 years, except of Hodgkin lymphoma and acute lymphocytic leukaemia. Overall survival for patients aged 75 years and older with haematological malignancies is poor, notably for acute leukaemias. The burden of hematologic malignancies is generally higher in men, and the burden of leukemia from occupational exposure to benzene and formaldehyde is more widespread in areas with low SDI.

These disorders have a substantial impact on global health, posing challenges for health care systems worldwide. The projected global trends in hematological malignancies are for them to be increasing. By 2030, the incidence rates per 100,000 individuals are expected to rise. Prevention and early detection programs are needed to mitigate the increasing incidence of these malignancies.

Types

Below is a list of blood cancers, not an exhaustive list, and some sources may group or categorize blood cancers differently.:

1. Leukemia: Acute Lymphoblastic Leukemia (ALL); Acute Myeloid Leukemia (AML); Chronic Lymphocytic Leukemia ; Chronic; Myeloid Leukemia; Hairy Cell Leukemia; T-cell Prolymphocytic Leukemia.
2. Lymphoma: Hodgkin Lymphoma (HL); Non-Hodgkin Lymphoma (Follicular Lymphoma, Diffuse Large B-cell Lymphoma , Mantle Cell Lymphoma, Peripheral T-cell Lymphoma, Cutaneous T-cell Lymphoma)

3. Myeloma: Multiple Myeloma; Smoldering Multiple Myeloma; Plasma Cell Leukemia

4. Other blood cancers: Waldenström's Macroglobulinemia; Polycythemia Vera; Essential Thrombocythemia; Primary Myelofibrosis; Myeloproliferative Neoplasms; Myelodysplastic Syndromes; Aplastic Anemia; Paroxysmal Nocturnal Hemoglobinuria.

Symptoms

Blood disorders can manifest in various symptoms across the body. Some symptoms that may indicate a blood disorder include:

• A blood clot, which can cause swelling, redness, warmth in the leg, or shortness of breath.
• Petechiae, which can be caused by a low platelet count.
• Blood blisters in the mouth, resulting from a low platelet count or clotting issues.
• Swollen lymph nodes, often associated with white blood cell cancers such as leukemias or lymphomas.
• Pallor, which can be a sign of anemia.
• Pica, which can be caused by iron deficiency anemia.

Physiotherapy

Treatments for haematological malignancies include chemotherapy, immunotherapy, and autologous or allogeneic stem cell transplantation. The combination of the malignancy, and side effects of treatment often lead to a decrease in physical activity. Adverse effects often occur due to repeated treatments for the disease, hospitalisation, and prolonged immobility such as a lack of energy, whole body muscle weakness, physical de-conditioning, fatigue, and stress, and reduced health-related quality of life.

Physiotherapy management in blood cancer is centred around physical activity and exercise training. Prescription ranges from assisted mobilisation or gentle chair-based exercises at times during inpatient treatment when blood counts are low, scaling up to moderate- to high-intensity aerobic and resistance exercise training before or after treatment in outpatient settings. Each time along the clients journey will need a unique exercise plan and be frequently reviewed and adjusted if needed.

Exercise his a promising and effective rehabilitation strategy for cancer patients and can positively impact the muscle strength and QoL of cancer patients and physical functions. Additionally it can mitigate fatigue, pain, insomnia, and dyspnoea. No improvements were found in regards to complaints of nausea/vomiting, loss of appetite and diarrhoea.

Examples of exercises choosen in the studies in: moderate cycling, walking, nordic walking, running and swimming. These kinds of sports are easy to regulate with regards to load control, as well as programmes, such as moderate strength training and aerobic exercise programmes.

In recent years exercise as treatment for these conditions is growing and previous concerns related to exercise and safety are now less, and today a strong rationale for physiotherapy and exercise training is evident. With prevalence of blood cancer increasing, high-quality evidence to inform clinical practice is still needed. Questions include: the optimal type, timing and setting of exercise training; the cost-effectiveness of programs; the impact on overall survival; and longer-term patient outcomes beyond 1 year post-treatment

The Future

Hematologic malignancies comprise a heterogeneous group of diseases. Advances in our understanding of the pathogenesis of hematologic malignancies have been progressing at great speed. It is common now that cenrers do targeted sequencing of “cancer genes” on a patient's tumor, revolutionizing how we diagnose and treat patients with these diseases and other cancers as well, and will continue to evolve in the future.