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Hematologic Cancers
Director
Dr. Stéphane de Botton
Contact
+33 (0)1 42 11 67 15
Key Takeaways
Hematologic cancers, also known as malignant hematologic disorders, encompass a wide range of very different diseases that affect the blood, bone marrow, or lymphatic organs. An accurate diagnosis is essential for selecting the most appropriate treatment.
Understanding the Disease
Hematologic cancers occur when certain blood cells or their precursors multiply abnormally. Unlike solid tumors, they do not always form a mass. They can develop in the bone marrow—where blood cells are produced—in the blood, in the lymph nodes, or in other organs of the lymphatic system.
They include, in particular, leukemias, lymphomas, and multiple myeloma, as well as several rarer myeloid disorders. Their progression can be rapid or slow. Some forms require immediate treatment, while others may initially be managed through regular monitoring.
Gustave Roussy's Expertise
The Hematology Committee brings together the expertise needed to diagnose and treat malignant blood disorders. Care is based on laboratory and imaging tests, outpatient or inpatient treatments, hematopoietic stem cell transplants, and, for certain indications, cell therapies.
Major Hematologic Cancers
Classification is based on the cell lineage involved, the degree of maturation of the abnormal cells, their biological and molecular profile, and the rate at which the disease progresses.
They are characterized by the rapid accumulation of immature blood cells, called blasts. They can be myeloid or lymphoblastic and generally require prompt treatment.
They often progress more slowly. These include, in particular, chronic myeloid leukemia and chronic lymphocytic leukemia.
They develop from lymphocytes and primarily affect the lymph nodes or other lymphatic organs. There are two main types: Hodgkin lymphoma and numerous types of non-Hodgkin lymphoma.
It affects plasma cells, which are immune cells found in the bone marrow. In particular, it can affect the bones, the kidneys, and normal blood cell production.
This group includes essential thrombocythemia, Vaquez disease, and myelofibrosis. In these conditions, the bone marrow produces excessive amounts of one or more types of blood cells.
They result from inefficient or abnormal blood cell production. Some forms can progress to acute myeloid leukemia.
This disease exhibits both myelodysplastic and myeloproliferative features.
They are associated with an abnormal accumulation of mast cells in one or more organs. Their forms and course vary widely.
One general term, different diseases
The term “blood cancer” makes it easier to understand, but it encompasses diseases whose mechanisms, progression, and treatments vary greatly. Only a specialized diagnosis can determine the specific disease involved.
Symptoms and Circumstances of Discovery
Possible symptoms vary depending on the disease and are not specific to hematologic cancer. Some blood disorders are discovered incidentally during a blood test. Others present with changes in overall health, recurrent infections, unusual bleeding, or an enlarged lymph node.
- Persistent fatigue, pallor, or shortness of breath, which may be related to anemia.
- Unexplained fever, profuse night sweats, or unintentional weight loss.
- Recurrent or difficult-to-control infections.
- Frequent bruising, unusual bleeding, or small red spots on the skin.
- Enlarged lymph nodes, usually painless and persistent.
- Bone pain, particularly in certain forms of multiple myeloma.
- A feeling of heaviness or an enlarged abdomen, sometimes related to the spleen.
When should you see a doctor?
An isolated symptom usually has another cause. However, a persistent sign, an abnormality in a complete blood count, or a combination of several symptoms warrants medical evaluation. A rapid worsening of symptoms or a severely compromised general condition requires immediate evaluation.
The Diagnosis
Diagnosis begins with a medical history, a physical examination, and a blood test, which most often includes a complete blood count. Depending on the situation, additional tests may be necessary to accurately identify the disease and assess its extent.
It measures the different types of blood cells and looks for abnormalities in their numbers or appearance.
A myelogram and, in some cases, a bone marrow biopsy are used to examine the cells produced in the bone marrow.
A biopsy may be necessary to diagnose and characterize lymphoma.
Immunophenotyping, cytogenetics, and molecular analyses help determine the disease subtype and can guide the prognosis or treatment selection.
CT scans, FDG-PET scans, MRIs, or other tests may be used, depending on the disease, to identify the affected areas.
Tests are conducted to assess the patient’s overall condition, cardiac, renal, and hepatic function, as well as the risk of infection, in order to tailor the treatment strategy.
A collegial decision
Once the diagnosis has been made, the case can be discussed at a multidisciplinary team meeting to determine a treatment strategy tailored to the type of disease, its progression, the patient’s biological characteristics, and the patient’s situation.
Care at Gustave Roussy
Patients are referred to physicians who specialize in their condition. The care pathway may include outpatient visits, day hospital care, conventional hospitalization, or care in a secure unit, depending on the treatment and level of monitoring required.
The teams treat acute and chronic leukemias, lymphomas, multiple myeloma, myeloproliferative neoplasms, myelodysplastic syndromes, and mastocytosis.
Doctors work with the clinical laboratory, imaging, and pathology teams to accurately characterize each blood disorder.
The oncology and hematology outpatient clinic treats patients when treatment, monitoring, a transfusion, or certain procedures can be performed without requiring a full hospital stay.
They are intended for patients whose immune systems are severely compromised, particularly during certain intensive treatments or following a transplant.
Gustave Roussy performs autologous and allogeneic hematopoietic stem cell transplants when indicated.
The teams participate in trials comparing new strategies to standard-of-care treatments, as well as in early-phase trials when circumstances permit.
The Main Treatments
The choice of treatment depends on the disease, its stage or risk level, its biological and molecular characteristics, previous treatments, age, and overall health. Several approaches may be used in combination or sequentially.
It acts on rapidly dividing cells. The method, intensity, and duration of treatment vary depending on the disease.
Monoclonal antibodies and other treatments either activate the immune system or target proteins found on diseased cells.
They act on a molecular abnormality or a specific mechanism of the disease, once a relevant target has been identified.
It may be recommended in certain situations, particularly to treat a specific area.
It allows for the administration of intensive treatment for certain diseases, followed by the restoration of blood cell production.
These modified T cells may be offered as a treatment option for certain blood disorders, based on specific indications and following a specialized evaluation.
Hematopoietic Stem Cell Transplantation
Hematopoietic stem cells give rise to red blood cells, white blood cells, and platelets. A transplant aims to restore functional blood production after intensive treatment or to replace diseased bone marrow, depending on the situation.
The patient's stem cells are collected, stored, and then reinfused after intensive treatment. They enable the bone marrow to resume producing blood cells.
The stem cells come from a compatible donor. In addition to replacing the bone marrow, the donor’s immune cells can help fight the disease. This procedure requires specialized monitoring.
Before the transplant, a treatment called conditioning is administered. Its type and intensity are tailored to the disease and the patient.
After the transplant, close monitoring helps prevent and treat infections, immunological complications, and other adverse effects.
Key Takeaways
A transplant is not indicated for all blood disorders. The decision depends on the disease, its response to treatment, the patient’s profile, and—in the case of an allogeneic transplant—the availability of a compatible donor.
CAR-T cell therapies
CAR-T cells are a form of cellular immunotherapy. T cells are collected from the patient and then modified in the laboratory to express a receptor capable of recognizing a target present on certain cancer cells. After being multiplied, they are reinfused into the patient to identify and destroy the cells carrying this target.
T cells are collected from the blood via cytapheresis.
They are modified and propagated in a specialized facility.
A short course of chemotherapy prepares the body to receive the cells.
CAR-T cells are reinfused via infusion.
Close monitoring allows for the evaluation of the response and the prompt management of adverse effects.
A highly restricted indication
CAR-T cells are not used to treat all hematologic cancers. They are used in specific situations, particularly for certain types of leukemia, lymphoma, and multiple myeloma. Eligibility is evaluated on a case-by-case basis by a specialized team.
Adverse Effects and Supportive Care
Side effects depend on the disease, the treatment, its intensity, and the patient’s condition. Before treatment begins, the care team explains the possible risks, the signs that warrant contacting the department, and the preventive or treatment measures.
Illness or treatment can weaken the immune system. Prevention, biological monitoring, and prompt treatment of infections may be necessary.
A decrease in red blood cells can cause fatigue or shortness of breath. A decrease in platelets increases the risk of bleeding. Transfusions may be recommended based on lab results and symptoms.
Fatigue may be related to the disease, treatments, anemia, sleep, or malnutrition. Treatment is tailored to its various causes.
Preventive treatments and nutritional guidance can help minimize the impact on diet and weight.
Some treatments can affect fertility. When circumstances permit, a fertility preservation consultation may be offered before treatment begins.
Support may be offered to the patient and their loved ones to help them cope with the psychological, family-related, social, or occupational consequences of the illness.
If you have a fever
In a patient being treated for a blood disorder, a fever may require urgent evaluation. The specific instructions provided by the healthcare team must always be followed.
Research and Innovation
Clinical research in the Department of Hematology is overseen by Committee 110. It evaluates new therapeutic strategies, whether through trials comparing a standard treatment to a new approach, early-phase trials, or biological studies conducted with the patient’s consent.
Gustave Roussy also conducts research on leukemias, myeloid blood disorders, and cell therapies. The CELL-ATTACK program aims, in particular, to improve the efficacy, persistence, and precision of CAR-T cells, to better understand resistance mechanisms, and to identify new therapeutic targets.
Participate in a clinical trial
Participation is always voluntary. The team explains the study’s objective, the planned treatments or tests, the expected benefits, the risks, and the alternatives. Eligibility depends on the specific criteria of each protocol.
Join a clinical trial
Many clinical trials are open to patients with cancer. Participating in a clinical trial provides access to innovative treatments while contributing to the development of new therapies.
Contacts
Dr. Stéphane de Botton
+33 (0)1 42 11 67 15
Appointments and Second Opinions
Frequently Asked Questions
No. Leukemias and multiple myeloma develop primarily in the bone marrow and blood. Lymphomas can form lymph node masses or spread to other organs.
No. There are many non-cancerous causes that can affect blood counts. However, a persistent or significant abnormality should be evaluated by a doctor.
No. It is offered only for certain diseases and in certain situations, following a thorough assessment of the expected benefits and risks.
No. They are reserved for certain blood disorders and specific situations. The case must be evaluated by a specialized team.
Yes. A second opinion can help confirm the diagnosis, discuss treatment options, or assess eligibility for a clinical trial.