Some people diagnosed with blood cancer, particularly a slow-growing form, may not need treatment straight away, and some may never need treatment. The doctor may recommend ‘watch and wait’, usually considered when the symptoms are not troublesome, and the doctor believes there is no benefit to starting treatment straight away. Watch and wait is a safe option that avoids the side effects caused by many types of cancer treatment, treatment may be recommended at a future date, if or when needed.

If watch and wait is recommended, regular appointments with the doctor will be necessary to check general health and symptoms, specifically to monitor whether the blood cancer remains stable or starts to progress.

Chemotherapy is the use of potent drugs or chemicals, often in combinations and given at regular time intervals, to kill or damage the blood cancer cells in the body. The chemotherapy drugs must be toxic enough to kill the blood cancer cells, it is therefore a harsh treatment option. All chemotherapy drugs interfere with cancer cells’ ability to grow or multiply. However, the drugs toxicity can harm the healthy cells as well which results in unpleasant side effects.

The ultimate goal of chemotherapy treatment is to damage or kill the blood cancer cells so there’s either no sign of illness (remission) or the disease’s progress is slowed. Chemotherapy can produce long-term remission or outright cure for many people, depending on the blood cancer type and the severity of the disease.

Radiotherapy can be used to treat all types of blood cancer but more commonly used to treat Hodgkin lymphoma or Non-Hodgkin lymphoma.

Radiotherapy uses high-energy rays, such as x-rays, to destroy the blood cancer cells. Radiotherapy works by damaging the genetic material (DNA) within cells, which prevents them from growing and multiplying. Although the radiotherapy is directed at cancer cells, it can also damage nearby healthy cells. When radiotherapy is used for blood cancer treatment, it’s usually part of a treatment plan that includes drug therapy.

The treatment usually involves regular daily hospital visits to receive the radiotherapy but will not require a hospital stay. It may take several weeks to complete a course of radiotherapy.

Blood stem cells are produced in the bone marrow to become all the different types of blood cell the body requires. The blood stem cells are constantly dividing and maturing into different types of blood cells, replacing older and worn-out blood cells in the body.

Healthy stem cells are needed to live. When cancer or cancer treatments destroy the stem cells, stem cell transplantation (SCT) may be the best treatment option. Stem cell transplantation (SCT) is a procedure in which a patient receives healthy stem cells to replace faulty stem cells.

Before SCT, the patient receives high doses of chemotherapy, and sometimes radiation therapy, to prepare the body for transplantation. This is called “conditioning treatment.” After the stem cells are infused into the patient’s bloodstream, they travel to the bone marrow and begin the process of forming new, healthy blood cells including white blood cells, red blood cells and platelets. This process is called “engraftment.”

The main types of SCT are:

• Autologous transplantation uses the patient’s own stem cells. These cells are removed, treated and returned to his or her own body after a conditioning regimen.
• Allogeneic transplantation uses stem cells from a donor. A donor may be a family member or someone who is not related to the patient.

Immunotherapy, also known as biological therapy, uses the body’s own immune system to eradicate the blood cancer.

The immune system is designed to defend against disease-causing germs such as viruses and bacteria, including cancer cells, with the ultimate goal to keep us healthy. However, cancer can survive unchecked in the body because the immune system doesn’t recognise cancer as different. There are several different types of immunotherapies available to treat blood cancers, in recent years a very effective type has been developed called Chimeric Antigen Receptor T-Cell therapy (CAR-T therapy).

CAR-T therapy is a new type of treatment that uses the immune system to kill cancer cells. In some cases CAR-T therapy has cured people where all other treatments have failed.

CAR-T therapy works by taking some T cells (blood cells that usually help to protect from infection and disease) out of the blood, genetically modifying them in a research laboratory so they are much better at recognising, finding and killing cancer cells, and then putting them back into the blood to eradicate the cancer.

The process of CAR-T therapy may take several weeks and has several stages:

• T cells are taken from the blood, using a tube inserted into a vein in the arm. This may take two to three hours.
• The extracted T cells are taken to a laboratory and genetically modified, turning them into CAR-T cells. This may take two to three weeks.
• CAR-T cells are put back into the bloodstream via a drip. This process may last a few hours.
• Once in the bloodstream, the CAR-T cells should now attack and eradicate the blood cancer cells.

Currently three types of CAR-T therapy are available in the UK. They are Kymriah (tisagenlecleucel), Yescarta (axicabtagene ciloleucel) and Tecartus (brexucabtagene autoleucel). In the UK CAR-T therapy has been approved to treat only a limited number of blood cancers and people, is not available for everyone diagnosed with blood cancer.

In England, Scotland Wales and Northern Ireland, CAR-T therapy has been approved to treat:

• Children and adults up to the age of 25 with B-cell acute lymphoblastic leukaemia (ALL), whose first treatment has been unsuccessful.
• Adults with types of Non-Hodgkin lymphoma called diffuse large B-cell lymphoma (DLBCL) or primary mediastinal large B-cell lymphoma (PMBCL), whose lymphoma has continued to grow after at least two treatments.

In England, Scotland Wales and Northern Ireland, CAR-T therapy can also be given through the Cancer Drugs Fund (CDF) and other patient access schemes to:

• Adults with mantle cell lymphoma, whose lymphoma has continued to grow after two prior treatments including a Bruton’s tyrosine kinase (BTK) inhibitor such as ibrutinib.