It is one of the prices to pay for the extension of the average life. More and more people, in fact, with advancing age become ill with cancer. And among all the neoplasms, those affecting the blood have an important incidence among people over the age of 65. With over 33,000 new cases diagnosed every year, hematological cancers are in fifth place in the ranking of the most frequent cancers in our country. Figures destined to increase in the future precisely due to the close correlation with advancing age, a factor that also affects the type and effectiveness of the treatments available. This was discussed in the Time of Health with two of the leading Italian experts: Paolo Corradini, president of the Italian Society of Hematology and director of the Hematology Division of the IRCCS National Cancer Institute of Milan, and Alessandra Tedeschi, head of the study and therapy program of chronic lymphoproliferative disorders at the Hematology of the Niguarda Cancer Center, Niguarda Hospital in Milan.
Diagnosis and therapies
But for what reasons are tumors “typical diseases of the elderly”? Meanwhile, with age, risk factors accumulate and the body’s ability to “repair itself” decreases. However, the possibilities for treatment are also increasing. «Today 70% of people with a diagnosis of haematological neoplasm in Italy are alive 10 years after diagnosis, an important milestone and, for many subtypes of tumors, unthinkable until a few years ago – underlined Corradini -. And survival in our country is equal to or even higher than the European average. The chances of recovery depend on many variables (starting with the type of cancer, the stage and the general condition of the individual), but an increasing number of people live with a tumor for many years, transforming it into a chronic disease “.
Unfortunately it is difficult to reach an early diagnosis of a blood cancer: the initial signals are always rather subtle and not very specific because they could also be a warning of many other pathologies (often similar to those of a bad flu). «However, it is important to speak to a doctor in the presence of symptoms such as: fever or fever (particularly in the afternoon or at night) and a sense of weakness that persist without apparent cause for more than two weeks; pain in the bones or joints that does not go away; loss of appetite and sudden and unjustified weight loss; painless swelling of a superficial lymph node in the neck, axillary or inguinal – said Corradini -. Excessive sweating may also be present, especially at night, which forces you to change clothes and persistent itching spread all over the body ». It is the doctor who, after the visit, may decide to prescribe tests (more or less specific blood tests depending on the suspicions) and, if he deems it appropriate, suggest to consult a haematologist for a more in-depth evaluation.
Progress
«The rapid advances in medicine have made it possible, thanks to the arrival of innovative treatments, to cure or even cure many haematological tumors, prolonging the survival of patients and at the same time improving the quality of life – explained Alessandra Tedeschi -. Our therapeutic armamentarium is wide, ranging from traditional and always effective chemotherapy associated with immunotherapy to new target drugs or new monoclonal antibodies up to cellular therapies such as bone marrow transplantation and CAR-T. Obviously, each therapy finds a particular indication that strictly depends on the type of haematological tumor and the patient’s condition. There are many haematological disorders, some unfortunately very aggressive and others that progress very slowly, which we call chronic or indolent ».
The latter also include Waldenström’s macroglobulinemia, a subtype of lymphoma, which mainly affects the elderly, over seventy, and whose initial symptoms can be common to many other diseases. However, it should be emphasized that in most cases the diagnosis is made thanks to classic control blood tests. About a quarter of patients with Waldenström’s macroglobulinemia are asymptomatic and do not need immediate treatment, but only have periodic checks. “On the other hand, when the therapies are necessary, we proceed according to the individual case, based on the characteristics of the disease and the age of the patient – said Tedeschi -. In a very small percentage of patients it is necessary to act in urgent conditions with sessions of plasmapheresis (plasma subtraction) to reduce the viscosity of the blood due to the accumulation of an abnormal protein. In most cases, when the disease becomes symptomatic, we have numerous weapons available for treatment such as the monoclonal antibody, rituximab, combined with chemotherapy or the proteasome inhibitor bortezomib. In the past we have also used therapy regimens containing purine analogues (fludarabine, caldribrin) and, in younger patients, also autologous stem cell transplantation. In recent years, the treatments available for this rare subtype of lymphoma have significantly expanded thanks to the introduction of target therapies such as BTK inhibitors ». These are targeted drugs capable of inhibiting, only in the tumor cell, those signals that favor its survival. They are administered by mouth, with an excellent tolerability profile, a rapid and excellent control of the disease and are able to slow down its progression. Among the advantages of this type of therapy is that of making treatment more acceptable in elderly people, perhaps already tried by other pathologies, and limiting access to the hospital. «Ibrutinib is the first BTK inhibitor approved in Waldenstrom’s Macroglobulinemia – concluded the expert -. The arrival of a next generation inhibitor (zanubrutinib) is expected shortly, which in a study comparing with ibrutinib has been shown to be a better option for those patients who have previously received at least one first-line therapy or for those who have not. suitable for chemo-immunotherapy “. All therapies that are also available in Italy, and that today are provided by the health system for as long as necessary for every citizen.