AND GOOD EVENING.

THANK YOU FOR WATCHING HEALTHLINE ON PBS'S FORT WAYNE HIGH MARK EVANS, YOUR HOST TONIGHT'S SUBJECT IN TOPIC TO TALK ABOUT BLOOD CANCERS AND A VERY SPECIAL GUEST WHO HAS BEEN HERE.

THIS IS HIS FIRST TIME DR. ROBERT MANGUS AND YOU'RE A HEMATOLOGIST AND BEFORE THE SHOW HAS ACTUALLY STARTED I TOLD YOU I DON'T THINK WE'VE HAD A HEMATOLOGIST ON THE SHOW AT LEAST I'VE NEVER INTERVIEWED ONE.

SO ABOUT TIME YEAH.

IT IS ABOUT TIME.

SO EXACTLY.

WE'RE GOING TO FIND OUT WHAT A HEMATOLOGIST IS.

BUT I ALSO WANT TO INVITE OUR VIEWERS TO GIVE US CALLS IF THEY HAVE QUESTIONS OR CONCERNS ABOUT BLOOD CANCERS.

THE TELEPHONE NUMBER OF COURSE IS ON YOUR SCREEN EIGHT SIX SIX NINE SIX NINE TWO SEVEN TWO ZERO.

THAT PHONE LINE WILL BE OPEN FOR YOU DURING THE ENTIRE SHOW AND WE HAVE A HALF AN HOUR TO FILL UP WITH LOTS OF QUESTIONS.

SO LET'S GO AHEAD AND GET STARTED.

I'M SURE A LOT OF PEOPLE WOULD LIKE TO KNOW WHAT A HEMATOLOGIST IS AND WHY WOULD SOMEBODY NEED TO COME TO SEE YOU?

SURE, SURE.

SO IT'S BASICALLY A DOCTOR THAT DEALS IN BLOOD DISEASES.

SO I DO SEE A LOT OF CANCERS ALTHOUGH A LOT OF WHAT I SEE IS BENIGN DISORDERS, MAYBE A TOPIC FOR ANOTHER DAY.

A LOT OF IRON DEFICIENCY ANEMIA, BLOOD COUNT ABNORMALITIES, WHITE CELLS, RED CELLS, PLATELETS.

SO THEY WOULD COME TO SEE ME IF THEY WERE HAD CBC OR BLOOD COUNT ABNORMALITIES, IF THEY HAD LYMPH NODES THAT WERE ABNORMAL.

OFTEN IT'S ON REFERRAL FROM A PRIMARY DOCTOR OR EMERGENCY DEPARTMENT.

SO IT'S USUALLY DIRECTLY IT'S USUALLY ON REFERRAL.

OK, AND THAT WAS GOING TO BE ONE OF MY QUESTIONS LATER.

BUT YOU TOOK CARE OF THAT JUST FINE.

HOW LET'S EDUCATE NOT ONLY ME THE HOST BUT ALSO OUR VIEWERS HOW MANY DIFFERENT TYPES OF BLOOD CELLS DO WE HAVE AND SURE.

AND WHAT ARE THEY SURE?

SO WE HAVE THREE MAIN TYPES THAT WE LOOK AT.

SO WE HAVE WHITE CELLS BUT EVEN WITHIN WHITE CELLS THERE'S DIFFERENT TYPES OF WHITE CELLS WHICH I WON'T SPEND HOURS ON BUT NEUTROPHILS LYMPHOCYTES MONOCYTES THERE'S OTHERS.

THEN THERE'S RED BLOOD CELLS.

THOSE ARE THE ONES THAT CARRY THE OXYGEN, THE TISSUES.

SO IF YOU ARE LOW ON RED BLOOD CELLS THAT ARE ANEMIC YOU MAY BE A LITTLE TIRED THEN THERE'S BLOOD PLATELETS THAT HELP YOU FORM A PLUG IF YOU GET A CUT OR SCRAPE.

OK, SO IF THEY'RE TOO LOW YOU CAN GET BRUISING OR BLEEDING OK WE BROKE THAT DOWN VERY SIMPLY IN LAYMAN TERMS FOR US WHAT ARE THE MAJOR OR THE MOST COMMON TYPES OF BLOOD CANCERS?

SURE.

HOW DO THEY DIFFER?

SURE.

SO WE USUALLY BREAK IT DOWN.

YOU CAN SUBDIVIDED INTO 60 OR 100 DIFFERENT TYPES BUT WOW USUALLY WE DIVIDE IT INTO LEUKEMIAS WHICH IS STILL A BROAD CATEGORY OF ACUTE AND CHRONIC LYMPHOCYTIC LYMPHOCYTIC AND MONOCHROMATIC MYELOID.

SO LEUKEMIAS LYMPHOMAS WHICH ARE GENERALLY LYMPH NODE ENLARGEMENTS BUT ABNORMAL LYMPH TISSUE AND THEN FINALLY MULTIPLE MYELOMA WHICH IS A DISORDER OF WHAT ARE CALLED PLASMA CELLS WITHIN THE BONE MARROW WHICH ARE IMMUNE FIGHTING, IMMUNE PRODUCING CELLS WITHIN THE MARROW THAT CAN CAUSE OTHER PROBLEMS THAT LEAD TO THIS DISEASE.

WELL, LET'S BREAK THIS DOWN AND YOU DID BASICALLY THREE CATEGORIES LEUKEMIA, LYMPHOMA AND MYELOMA.

BUT THERE ARE MORE THAN ONE TYPE OF LEUKEMIA.

ABSOLUTELY.

ABSOLUTELY.

SO YOU'VE GOT ACUTE LEUKEMIA AND CHRONIC LEUKEMIA IS THE MOST COMMON TYPE IS ACUTE MYELOID LEUKEMIA SOMETIMES KNOWN AS A EMELLE AND EVEN WITHIN THEIR OFTEN YOU'LL SEE PRECURSOR OR POORLY FORMED MARROW.

PRIOR TO THAT SOME PEOPLE WILL HAVE A CONDITION CALLED MDX OR MILD DYSPLASIA THAT SORT OF LEADS TO LEUKEMIA THAT THAT'S COMMON SOMETHING CALLED CHRONIC LYMPHOCYTIC LEUKEMIA OR CML IS EXTREMELY COMMON.

MANY OF THOSE PATIENTS WE CAN JUST OBSERVE THEN YOU'VE GOT THE LESS COMMON TYPES IN ADULT AND ADULT DOCTORS.

SO I'M NOT SEEING KIDS BUT ACUTE LYMPHOBLASTIC LEUKEMIA OR AML AND THEN FINALLY SOMETHING CALLED CML OR CHRONIC MYELOCYTIC LEUKEMIA THAT'S SORT OF AN ALPHABET SOUP AND IT GETS COMPLICATED BUT BUT THOSE ARE THE MAIN TYPES AND EVEN WITHIN AML WE CAN SUBDIVIDE IT INTO OTHER TYPES WHICH IS PROBABLY BEYOND THE SCOPE OF THIS DISCUSSION.

OK, WELL ANY BREAK THOSE DOWN JUST FINE AND YOU KNOW, I NOTICE SOMETHING HERE TO IT.

IT SEEMS AS IF THE BLOOD CANCERS ARE THEY HAVE THEIR OWN CHARACTERISTICS FROM THE SOLID TUMOR.

YEAH.

IF YOU WILL.

RIGHT.

SO SO IT'S A LITTLE BIT OF A DIFFERENT SITUATION.

FOR INSTANCE USUALLY THESE WE DON'T HAVE ANY SCREENING PROGRAMS FOR THESE IF YOU FEEL WELL YOU'RE GOING TO THE DOCTOR A BLOOD COUNT OR CBC ISN'T NECESSARILY AN AUTOMATIC PART OF THAT EVALU ALTHOUGH IT'S COMMON BECAUSE A LOT OF PEOPLE HAVE FATIGUE AND FATIGUE FOR A VARIETY OF REASONS, ONE OF WHICH IS ANEMIA.

YOU CAN HAVE EASY BROUS ABILITY FOR A VARIETY OF REASONS, ONE OF WHICH IS A LOW PLATELET COUNT.

SO SOMETIMES SO IT'S A LOW THRESHOLD FOR CHECKING AND SOMETIMES THAT'S WHERE THE THE DIAGNOSIS STARTS IS THE BLOOD COUNT IN THE PRIMARY CARE OFFICE OK AND HOW THROUGH THE BLOOD TEST YOU WOULD BE ABLE TO SEE WHAT THAT INDIVIDUAL HAS AS FAR AS WHAT OR AT LEAST HAVE STRONG SUSPICIONS THAT'S WHERE IT STARTS.

SO EITHER IN THE E.R.

IN THE PRIMARY OFFICE THEY MAY HAVE AN ABNORMAL BLOOD COUNT.

LET'S SAY THEIR WHITE COUNT IS LOW, THEIR RED BLOOD COUNT IS LOW, THEIR HEMOGLOBIN, THEIR PLATELET COUNT IS LOW.

THEN THEY'LL BE FUNNELED TO US TO LOOK AT THEIR BLOOD AND THEN TO DO A SECOND LEVEL OF TESTING.

SOMETIMES THAT TESTING INCLUDES WHAT'S CALLED A BONE MARROW EXAMINATION TO BE DISTINGUISHED FROM A BONE MARROW TRANSPLANT.

THIS IS JUST AN EVALUATION AND IT'S SOMETHING WE DO EVERY SINGLE DAY OF THE WEEK.

USUALLY I TELL PEOPLE THAT IT'S NOT AS BAD AS THEY'VE HEARD FROM THEIR NEIGHBOR OR THEIR RELATIVE BUT IT CAUSED A LITTLE BIT OF DISCOMFORT.

BUT IT'S AN OUTPATIENT PROCEDURE VERY QUICK, VERY EASY.

AND THAT'S WHERE OFTEN WE CAN GET THE DEFINITIVE DIAGNOSIS AND THAT'S THE NEEDLE GOING INTO THE STERNUM.

WELL, WE DO THAT OCCASIONALLY THESE DAYS.

MOST OF THE TIME WE DO THAT WHAT'S CALLED THE POSTER ILIAC CREST WHICH ISN'T THE REAR END BUT IT'S CLOSE.

IT'S NOT RIGHT IN THE BACK.

IT'S USUALLY A LOT EASIER IN THE STERNUM.

WE WILL DO THE STERNUM OCCASIONALLY BUT WE USUALLY RESERVED THAT FOR IF WE CAN'T GET IT ANY OTHER WAY.

OK, KIND OF THE LAST RESORT THAT'S SORT OF OK.

VERY GOOD.

I DO WANT TO REMIND OUR VIEWERS THAT WE ARE TAKING PHONE CALLS ON BLOOD CANCERS TONIGHT AT EIGHT SIX SIX NINE SIX NINE TO SEVEN TO ZERO.

FEEL FREE TO CALL WHETHER IT'S A CONCERN ABOUT YOURSELF OR SOMEONE YOU LOVE.

SO GIVE US A CALL.

THAT'S WHAT THE SHOW'S ALL ABOUT IS TO PROVIDE THAT INFORMATION.

AND YOU KNOW, WE JUST MENTIONED ABOUT HOW THE CHARACTERISTICS ARE A LITTLE BIT DIFFERENT BLOOD CANCERS VERSUS THE TWO TUMOR CANCERS.

BUT THE THE RISKS ARE DIFFERENT, AREN'T THEY?

YEAH, THEY'RE GENERALLY RISKS CIGARET SMOKING IS PROBABLY PLAYS A LITTLE BIT LESS OF A ROLE IN THIS ALTHOUGH CIGARET SMOKING IS A RISK FACTOR FOR ACUTE LEUKEMIA.

CERTAINLY RADIATION EXPOSURES ARE RISKS CERTAIN PESTICIDES, CHRONIC EXPOSURES.

THERE ARE SOME RISKS BUT A LITTLE LESS THAN SAY COLORECTAL CANCER AND IN LUNG CANCER WHERE WE HAVE A LITTLE BIT BETTER SCREENING METHODS REALLY WE DON'T REALLY HAVE A SCREENING PROGRAM FOR THESE DISEASES.

BUT WHAT ABOUT GENETICS?

HEREDITY?

SURE.

SO IT PLAYS A LITTLE BIT OF A ROLE.

IT CERTAINLY PLAYS LESS OF A ROLE THAN SAY COLORECTAL CANCER OR CANCER.

THERE ARE SOME INHERITED LEUKEMIAS BUT FAIRLY RARELY SAME IS TRUE OF MULTIPLE MYELOMA.

SAME IS TRUE OF CHRONIC LYMPHOCYTIC LEUKEMIA COMMONLY CALLED CLELL THAT IT'S JUST LESS COMMON IN THAT SITUATION.

BUT THERE ARE FAMILIES TYPICALLY IF WE HAVE SOMEONE MOST OF THE TIME THEY'RE NOT SEEING THE GENETIC COUNSELOR AS OPPOSED TO SOME OF THE OTHER CANCERS THAT WE DEAL WITH.

AND WHAT ABOUT OCCUPATIONS AND OCCUPATIONS THAT ARE CAUSING THE FARMER A FARMER FARMER WORKING WITH THE PESTICIDES?

YEAH.

HMM.

WOW.

OK, NOT TOO MANY OTHERS.

NO OK, THAT'S TOO BAD FOR THEM.

HOPEFULLY THEY'RE WEARING THE RIGHT GEAR.

YEAH YEAH.

IT'S NOT A HUGE RISK BUT IT'S IT'S IT'S THERE YEAH.

YEAH EXACTLY.

ANY SPECIFIC AGE GROUPS MORE PRONE TO BLOOD CANCER.

SURE MOST OF THESE ARE THE OLDER YOU ARE THE MORE CHANCE YOU HAVE TO GET A AN ABERRATION A MUTATION THAT LEADS TO THESE DISEASES.

THERE ARE A FEW EXCEPTIONS TO THAT TYPE OF LYMPHOMA CALLED HODGKIN'S LYMPHOMA HAS WHAT WE CALL A BIMODAL DISTRIBUTION WHERE WE SEE A LOT OF PEOPLE IN THEIR 20S GET IT AND THEN IN THE OLDER AGES GET IT.

BUT MOST OF THEM A LOT OF THEM PEACON THERE'S IN PEOPLE'S 60S IS THE HIGHEST INCIDENCE BUT IN GENERAL OLDER FOLKS DOESN'T LEAN TOWARD ONE GENDER OR ANOTHER.

A FEW OF THEM DO BUT MOST OF THEM ARE PRETTY WELL DISTRIBUTED.

EVENLY DISTRIBUTED AND WHAT ABOUT ETHNICITIES.

WELL IN MULTIPLE MYELOMA IT'S A LITTLE BIT HIGHER IN THE AFRICAN-AMERICAN POPULATION IT'S STILL VERY TREATABLE.

DO WE KNOW WHY?

I THINK IT'S JUST A MATTER OF GENETICS AGAIN, THERE IS SOME GENETIC INFLUENCE IN THAT SETTING AGAIN NOT AS MUCH AS CANCER BUT JUST CERTAIN MUTATIONS THAT CAUSES THESE ABNORMALITIES.

AND YOU MENTIONED HODGKIN'S.

LET'S SEE THERE'S SOMETHING IN MY NOTES HERE THAT I WANTED TO BRING UP HODGKIN'S LYMPHOMA VERSUS NON HODGKIN'S LYMPHOMA.

CAN YOU EXPLAIN THE DIFFERENCE?

YEAH, I CAN.

I'M SURE YOU CAN.

YEAH.

FOR HAVING SEX.

SO NON HODGKIN'S LYMPHOMA IS ACTUALLY MUCH MORE COMMON THAN HODGKIN'S LYMPHOMA.

IN FACT IT WAS ONLY IN THE LAST DECADE OR TWO THAT THEY ABSOLUTELY PROVED THAT HODGKIN'S WHAT THEY USED TO CALL HODGKIN'S DISEASE IS HODGKIN'S LYMPHOMA AND THAT WAS DESCRIBED IN THE EIGHTEEN HUNDREDS AND IT BUT IT BECAME CLEAR THAT THE NON HODGKIN'S WERE ABOUT FIVE OR SIX TIMES MORE COMMON.

AGAIN THERE'S MANY TYPES OF OF NON HODGKIN'S LYMPHOMA.

THERE'S ACTUALLY MANY DIFFERENT TYPES OF HODGKIN'S LYMPHOMA FOR MOST PEOPLE WITH HODGKIN'S LYMPHOMA OUR INTENT IS CURE AND SO OFTEN WE'RE FAIRLY AGGRESSIVE THERAPY IN THAT SETTING.

JUST AS AN ASIDE I THINK IT'S IMPORTANT ALTHOUGH THERE'S 60 DIFFERENT TYPES OF NON HODGKIN'S LYMPHOMA.

I'LL JUST I'LL JUST KEEP IT IN TWO BROAD TYPES.

THERE'S AN AGGRESSIVE TYPE THAT MAYBE HAS CURATIVE POTENTIAL BUT THAT'S A THREAT TO YOUR LIFE RIGHT AWAY AND THERE ARE OTHER SLOWER TYPES THAT MAYBE WE CAN TREAT BUT WE CAN'T GET RID OF .

BUT IF YOU DON'T MAKE THE TREATMENT WORSE THAN THE DISEASE, YOU CAN LIVE YEARS AND YEARS AND YEARS AND DIE OF OLD AGE SOMETIMES.

AND SO THOSE ARE BROAD CATEGORIES TO BE SURE.

AND WHAT ABOUT THE THE SIGNS OR THE SYMPTOMS?

SURE.

SO SOMETIMES THERE'S NO SIGNS AT ALL.

SOMETIMES IT'S YOU FIND ON A CBC AND SOMEBODY SPECIAL IF THEY'RE YOUNGER AND THEY DON'T HAVE A LOT OF OTHER HEALTH ISSUES THEY FEEL WELL.

BUT SOMETIMES IT'S FATIGUE.

I MEAN A LOT OF PEOPLE HAVE FATIGUE AND MOST OF THE TIME IT'S NOT THIS BUT YOU GO TO YOUR DOCTOR, GET A BLOOD COUNT ,YOU GET CHECKED OUT OCCASIONALLY IT'S BRUISING ONCE IN A WHILE IT'S A PRESENTATION OF SOMEONE THAT'S SICK, THAT'S ILL, THAT'S IN THE EMERGENCY DEPARTMENT OR IN THE HOSPITAL WITH INFECTION BECAUSE THE GOAL THE MAIN PURPOSE OF THE WHITE CELLS IS IMMUNITY.

AND SO IF THEY'RE THEY'RE NOT WORKING RIGHT, THEN YOU CAN'T FIGHT OFF INFECTION AND YOU'RE HAVING RAGING FEVERS AND AND SUCH LIKE THAT.

FOR SOME PEOPLE IT'S WEIGHT LOSS.

SOME PEOPLE IT'S JUST THEY FEEL THEIR NECK NOW WE ALL HAVE LYMPH NODES.

I CAN FEEL IT NODES IN MY NECK.

YEAH BUT IF THERE'S A CHANGE YOU KNOW OR IF IT'S A COUPLE CENTIMETERS OR GREATER THAN THE THAT'S WORTH GETTING CHECKED OUT TO AND I SAW SOMETHING IN MY RESEARCH ABOUT BRUISING WHAT ARE THESE BRUISES APPEAR AND HOW IT WAS CAUSE I'M SURE THEY CAN APPEAR ANYWHERE BUT IT'S IN AREAS ESPECIALLY CONCERNING WITHIN THE MOUTH OR IF YOU'RE I MEAN IF PEOPLE HAVE NOSEBLEEDS WELL THAT'S COMMON NOSE IS A COMMON AREA TO BLEED.

USUALLY IT'S A LOCAL PROBLEM.

BUT IF AND PEOPLE SAY THEY HAVE EASY VISIBILITY BUT SOMETIMES THEY'RE JUST DESCRIBING MINOR STUFF IF IF IF THEY HAVE LITTLE PINPOINT RED SPOTS SOMETIMES CALLED PETECHIAE ON THEIR FEET OR ANKLES, SOMETIMES THAT'S WORTH CHECKING OUT.

OH YEAH.

THAT WOULD BE A CONCERN I'M SURE.

AND I WAS LOOKING HERE FOR SOME OTHER OH YEAH WE'VE GOT THE FEVERS AND THE CHILLS IT KIND OF TIES IN WITH THE LYMPH NODES RIGHT.

YOU TALKED ABOUT THE FATIGUE YOU TALKED ABOUT OR WHAT ABOUT THE LOSS OF APPETITE, NAUSEA, NAUSEA AS A PRESENTING SYMPTOM IS ACTUALLY PRETTY UNCOMMON.

OK, PEOPLE SOMETIMES GET NAUSEA FROM OUR TREATMENT ALTHOUGH I MUST SAY I THINK WE DO A PRETTY GOOD JOB THESE DAYS AT PREVENTING THAT.

BUT I WOULD SAY A LOT LESS COMMON AGAIN SOMETIMES AND AGAIN GOING BACK TO LYMPHOMAS THERE'S SO MANY DIFFERENT TYPES ONCE IN A WHILE LYMPHOMAS CAN PRESENT IN THE GASTROINTESTINAL SYSTEM AND THEN CAUSE PROBLEMS THAT ALSO NIGHT SWEATS SOMETIMES AGAIN PEOPLE WHEN WHEN WE SAY NIGHT SWEATS WE REALLY MEAN SOAKING THE BED.

ARE YOU HAVING TO CHANGE YOUR SHEETS EVERY DAY MORE THAN JUST THE USUAL GET A LITTLE SWEATY AT NIGHT.

ALL RIGHT.

AND HEADACHES I THINK YOU COVERED THAT THE ABDOMINAL DISCOMFORT, SHORTNESS OF BREATH.

HOW WOULD A BLOOD DISEASE OR DISORDER AFFECT YOUR BREATH?

SURE.

SO THE LUNGS MAY BE PERFECTLY NORMAL BUT WHAT HAPPENS IS IF YOU GET ANEMIC WELL, THERE'S MORE THAN ONE MECHANISM.

ONE COMMON MECHANISM IS IF YOU'RE NOT MAKING THE RED BLOOD CELLS BECAUSE WE ALL HAVE TO MAKE NORMAL RED BLOOD CELLS EVERY 100 HUNDRED ONE HUNDRED AND TWENTY DAYS YOU HAVE TO KEEP MAKING NEW ONES AND SO IF THEY GET LOW THAT CARRIES OXYGEN TO THE TISSUE AND IT GIVES YOU THE EXACT SAME EFFECT AS IF YOU WERE HAVING LUNG PROBLEMS YOU CAN BE SHORT OF BREATH.

THERE ARE RARE CIRCUMSTANCES WHERE IF YOU HAVE AN EXTREMELY ELEVATED WHITE COUNT AND IT ACTUALLY INVADES INTO THE LUNG THAT CAN HAPPEN TO LESS COMMON.

BUT ONCE AND FREQUENT INFECTIONS THAT WOULD BE A KILLER SIGN SO YOU CAN GET FEVER FROM THE DISEASE DIRECTLY BUT YOU CAN ALSO BE SUSCEPTIBLE TO INFECTION.

TRUE, TRUE.

AN MRI SCANNER IS SKIN RASHES YOU YEAH SOMETIMES YEAH.

IT'S ALL RIGHT.

TAKE CARE OF THAT AND I WANT TO TALK ABOUT THE TREATMENT OPTIONS BUT WE HAVE A CALL THAT JUST CAME IN SO WE'LL GO AHEAD AND ADDRESS THAT AND LINDA WANTS TO BE OFFLINE AND A LOT OF OUR CALLERS PREFER THAT AND THAT'S QUITE ALL RIGHT.

I'LL READ A QUESTION THAT'S TRANSCRIBED.

IT SAYS CAN YOU DISCUSS STAGE THREE MULTIPLE MYELOMA MORE IN-DEPTH?

SURE.

SO MULTIPLE MYELOMA I'LL JUST START SINCE WE HAVEN'T REALLY TALKED ABOUT IT MUCH IS A CONDITION OF THE BONE MARROW OF THESE PLASMA CELLS.

BUT WHAT ARE THE PROBLEMS WITH MULTIPLE MYELOMA?

IT CAN CAUSE LOW BLOOD COUNTS, ANEMIA, INFECTION.

YOU CAN GET BONE PROBLEMS, YOU CAN GET BRITTLE BONES FROM IT.

YOU CAN GET KIDNEY PROBLEMS, YOU CAN GET CALCIUM PROBLEMS, FREQUENT INFECTIONS AND OTHER THINGS.

SO STAGING FOR MULTIPLE MYELOMA IS A LITTLE BIT DIFFERENT THAN SAY STAGING FOR COLON CANCER IN THAT IN MULTIPLE MYELOMA EVEN FROM THE BEGINNING WE THINK OF IT AS A WHOLE BODY CONDITION, NOT JUST A LOCATION WITH LYMPH NODES.

SO STAGE THREE IS MOST COMMONLY DESCRIBED AS HAVING ABNORMALITIES IN THE SERUM ALBUMIN OR WHAT'S CALLED BETA TO MICRO GLOBULIN.

SO DOES IT REALLY MATTER?

I THINK IT MATTERS A LITTLE BIT.

IT MATTERS FOR CLINICAL TRIALS BUT IT IS A VERY COMMON STAGE OF MYELOMA AND TYPICALLY WOULD BE TREATED AGGRESSIVELY AND USUALLY SUCCESSFULLY MULTIPLE MYELOMA.

I MUST ADMIT WE STILL THINK OF AS A CHRONIC CONDITION EVEN THOUGH THERE HAVE BEEN GREAT ADVANCEMENTS IN TREATMENT IN THE LAST FEW YEARS, WE STILL THINK OF IT AS A CHRONIC CONDITION BUT PEOPLE CAN LIVE MANY YEARS WITH IT.

WHEN I WAS IN MEDICAL SCHOOL THE AVERAGE SURVIVAL MYELOMA WAS TWO YEARS AND NOW IT'S APPROACHING A DECADE.

SO THAT'S ON THAT'S ON AVERAGE AND THERE'S THOSE PEOPLE THAT DO EVEN BETTER THAN THAT.

I WAS GOING TO ASK YOU ABOUT THE SURVIVAL RATES AND WE'LL GET TO THAT IN JUST A SECOND FOR THE TREATMENT OPTIONS.

BUT LET'S BREAK THIS DOWN.

WE'VE TALKED ABOUT LEUKEMIA, LYMPHOMA AND MY MYELOMA.

ARE THE TREATMENT OPTIONS THE SAME FOR ALL THREE OF THOSE CATEGORIES?

WELL, IN VERY, VERY BROAD TERMS.

SO I WOULD SAY IT IN BROAD TERMS SURGERY IS ALMOST NEVER A TREATMENT.

IT IS DIAGNOSTIC SOMETIMES.

SO IF YOU HAVE A BIG LUMP IN YOUR NECK YOU NEED TO REMOVE THAT SO THEY CAN LOOK AT IT IN THE MICROSCOPE.

SO SURGERY IS PART IN THAT SENSE.

BUT IN TERMS OF TREATMENT BY AND LARGE THESE ARE MEDICATIONS .

SOMETIMES RADIATION HAS A ROLE IN THIS TOO.

BUT MEDICATION IS THE MAINSTAY OF TREATMENT.

SOMETIMES THAT'S CHEMOTHERAPY, SOMETIMES IT'S NOT CHEMOTHERAPY DRUGS OR THE CHEMOTHERAPY DRUGS.

THEY'VE BEEN AROUND FOR QUITE A LONG TIME AND SO AS RADIATION ARE BRANCHING OUT INTO ANY OTHER TYPES OF TREATMENTS.

OH YEAH, ABSOLUTELY.

SO GETTING BACK TO THE MYELOMA QUESTION OK, YOU CAN NOW BE TREATED WITH NON CHEMOTHERAPY.

YOU CAN HAVE A MULTI DRUG REGIMEN THAT'S VERY EFFECTIVE AND THAT DOESN'T INCLUDE ANY CHEMOTHERAPY.

THAT'S NOT TO SAY THERE'S NO SIDE EFFECTS THERE CAN BE BUT MOST OF THEM ARE MANAGEABLE BUT VERY COMMON TO TREAT WITHOUT CHEMOTHERAPY IN THAT SETTING ALTHOUGH IT'S STILL USED SOMETIMES IN LYMPHOMAS, CHEMOTHERAPY STILL HAS A BIG ROLE BUT SO-CALLED TARGETED THERAPY OR ANTIBODIES HAVE REALLY MADE A BIG PUSH IN RECENT YEARS.

EVERY SINGLE YEAR THERE ARE NEW ANTIBODIES ARE TARGETED THERAPIES FOR ALL OF THESE DISEASES I WOULD SAY IN LEUKEMIA CHEMOTHERAPY STILL HAS A HUGE ROLE ALTHOUGH EVEN THERE THERE HAVE BEEN MOVEMENTS TOWARDS MORE TARGETED THERAPIES AND THERE ARE CERTAIN SUBTYPES OF ACUTE LEUKEMIA THAT THAT CAN BE TREATED WITH NON CHEMOTHERAPEUTIC REGIMENS.

I WILL SAY THAT GOING BACK TO CHRONIC LEUKEMIA OR S.L THAT IS COMMONLY TREATED WITH NON CHEMOTHERAPEUTIC REGIMENS, OFTEN WITH ORAL THERAPY AND AND SO I THINK THE TOXICITY PROFILE THERE STILL SIDE EFFECTS IS A LOT MORE MANAGEABLE THAN CERTAINLY WHEN I STARTED IN THIS TWENTY SEVEN YEARS AGO.

WHAT IF I HAD A BLOOD TRANSFUSION?

SURE, SURE.

SO WE TRANSFUSE A LOT OF PEOPLE SO IT'S IN IN LEUKEMIAS ACUTE LEUKEMIA.

IT'S EXTREMELY COMMON IF SOMEBODY HAS ACUTE LEUKEMIA, SERIOUS DISORDER, VERY TREATABLE OFTEN THEY'RE IN THE HOSPITAL FOR A MONTH AND THE REASON THAT THEY'RE IN THE HOSPITAL FOR A MONTH AT THE BEGINNING IS WE HAVE TO INDUCE A REMISSION.

WE HAVE TO GET REMISSION FIRST BEFORE WE CAN THINK ABOUT CURE AND THESE PEOPLE START OFF WITH LOW COUNTS FROM THE BEGINNING AND WE MAKE IT TEMPORARY WORSE WITH OUR TREATMENTS.

AND PART OF THE REASON THAT THEY'RE IN THE HOSPITAL SO LONG IS THAT THEY'RE NEEDING TRANSFUSION SOMETIMES NEARLY EVERY DAY OF RED CELLS AND PLATELETS.

I WOULD I'M NOT A DOCTOR OF COURSE, BUT I WOULD ASSUME TRANSFUSIONS WOULD BE A VERY IMPORTANT KEY ROLE.

OH, ABSOLUTELY.

HELPING PEOPLE WITH THESE KINDS OF DISEASES.

WE DO HAVE OTHER DISEASES.

I MENTIONED VERY BRIEFLY AGAIN A CONDITION CALLED MDS OR MILD OR DYSPLASIA IT'S OLDER TERM WAS PRE LEUKEMIA WHERE THEY'RE OUTPATIENT AND PERHAPS ARE OLDER AND MAYBE NOT A CANDIDATE FOR AGGRESSIVE THERAPIES BUT SOMETIMES THE TREATMENT IS RED CELLS ONCE A MONTH LIKE FILLING UP A TANK OF GASOLINE AND PEOPLE COULD DO WELL FOR A FAIRLY LONG PERIOD OF TIME ON THAT.

NOW THE BONE MARROW THAT HOW DO I EXPLAIN THIS THE BONE MARROW PRETTY MUCH DICTATES YOUR BLOOD HEALTH IS THAT CORRECT?

YEAH.

OK, SO HOW DOES THAT WORK?

I MEAN HOW DOES THE BLOOD GET DERIVED?

WE GET PROGRAMED FROM THAT THE BONE MARROW WELL WE ALL HAVE SO-CALLED STEM CELLS THAT BRANCH OUT INTO WHITE BASICALLY WHITE CELLS, RED CELLS AND PLATELETS.

WE ALL HAVE A COMMON STEM CELL BUT THEN THE PROGENITOR CELLS FOR EACH OF THOSE THREE CELL LINES AND AND BASICALLY THEY PRODUCE CELLS AND PLATELETS.

WE HAVE TO MAKE NEW PLATELETS EVERY EVERY SEVEN OR TEN DAYS.

SO WE'VE GOT TO KEEP HEALTHY THERE OR ACCOUNTABLE FOR RED CELLS.

IT'S NOT SO BAD.

I THINK I'VE MENTIONED ONE HUNDRED TO ONE HUNDRED AND TWENTY DAYS IS THE AVERAGE LIFESPAN.

RIGHT.

AND THE WHITE CELLS ARE JUST CONSTANTLY BEING MADE AND I NOTICE TOO THAT THERE'S ONE OF THE TREATMENTS IS STEM CELL TRANSPLANTS.

RIGHT.

HOW ARE THOSE DONE?

SO SO BASICALLY AND THAT'S NOT SOMETHING THAT'S DONE IN FORT WAYNE IF WE HAVE A PATIENT WITH THAT WE WORK CLOSELY WITH COLLEAGUES THERE IN INDIANAPOLIS OR SOMETIMES DETROIT, CLEVELAND ELSEWHERE.

OH WHERE WHERE BASICALLY THEY'RE GIVEN HEAVY DUTY CHEMO POTENTIALLY LETHAL DOSES BUT BEFOREHAND THEY THEY GET THESE STEM CELLS FROM THE CIRCULATING CELLS AND THEY CAN REALLY REDUCE THOSE CELLS AFTER THIS POTENTIALLY LETHAL DOSE OF CHEMOTHERAPY.

SO IT IS TRUE THAT A STEM CELL TRANSPLANT IS ESPECIALLY IMPORTANT PART OF MYELOMA BUT IT'S ALSO INVOLVED IN THE OTHER DISEASE.

WELL, WHEN YOU'RE HEARING A LOT ABOUT STEM CELL RESEARCH AND SOME OF THE MAGNIFICENT THINGS ARE DOING SO YOU KNOW, THIS COULD JUST BE THE BEGINNING.

SURE.

AND I DO WANT TO DISTINGUISH THE THE SO-CALLED AUTO TRANSPLANT OF MYELOMA WHICH IS DONE VERY COMMONLY MOST PEOPLE BELOW AGE 70 ARE GETTING IT THESE DAYS VERSUS SO-CALLED ALLOGENEIC TRANSPLANT WHICH IS OFTEN DONE IN ACUTE LEUKEMIA.

THAT'S A STEM CELLS FROM SOMEONE ELSE.

OH, OK. LET'S SEE.

YES, I WANTED TO TALK ABOUT THE THE CONCERNS THAT COVID-19 BROUGHT ON FOR PEOPLE WHO HAVE BLOOD CANCER OR ANY OTHER TYPE OF BLOOD DISEASES.

HOW HAS THAT VIRUS AFFECTED PEOPLE WITH THOSE CONDITIONS?

WELL, IN A VARIETY OF WAYS.

I MEAN CERTAINLY WHEN ALL IS STARTED A LITTLE OVER A YEAR AGO, THE FIRST THING I DID IS WE WERE NEVER SHUT DOWN COMPLETELY.

WE'RE ALWAYS TREATING PEOPLE THAT HAD TO BE TREATED BUT WE WERE RESTRICTING VISITORS.

WE STILL RESTRICTED TO ONE BUT BUT PEOPLE COULDN'T COME IN WITH THEIR YOU KNOW, THE PERSON THAT'S GETTING TREATMENT EVEN THOUGH THEY'RE OUTPATIENT, THEY'RE STILL THERE SOMETIMES FOR A FEW HOURS BY THEMSELVES AND OUR NURSES.

SO THAT WAS ONE WAY A SECOND WAY WAS THAT THAT IF SOMEBODY WAS ACTUALLY GETTING THE DIAGNOSIS, EVEN IF THEY WERE DOING PRETTY WELL, WE WERE FORCED TO DELAY THEIR TREATMENT BY A COUPLE OF WEEKS.

YOU KNOW, HOPEFULLY THAT ISN'T HURTING PEOPLE BUT YOU CERTAINLY DON'T WANT TO MAKE A HABIT OF THAT.

I THINK THE THE NEXT WAY IS THAT I THINK IN THESE DISEASES AND THIS IS I THINK WHAT'S KEY ABOUT THE HEMATOLOGIC DISORDERS AS OPPOSED TO SAY SOLID TUMORS ALTHOUGH THEY MAY HAVE IMMUNE SUPPRESSION, I THINK IT'S PARTICULARLY KEEN IN THE BLOOD CANCERS MULTIPLE MYELOMA ESPECIALLY.

BUT THE OTHERS AS WELL I THINK ARE MORE SUSCEPTIBLE TO A SERIOUS COMPLICATIONS OF THE DISEASE AND ALSO PROBABLY DO NOT MOUNT AS GOOD OR ANTIBODY RESPONSE TO THE VACCINE.

WE STILL ARE RECOMMENDING THAT THEY GET IT AT LEAST AS OF NOW .

WE ARE NOT STANDARDLY CHECKING ANTIBODY RESPONSES ALTHOUGH I WILL SAY HAVE DONE IN SELECTED CASES BUT CERTAINLY THAT'S AN UNKNOWN TO ME IS ARE WE GOING TO HAVE TO REVAMP CIDADE ALL OUR MYELOMA PATIENTS LATER?

THERE ARE CERTAIN DRUGS FOR INSTANCE I DON'T WANT TO GET TOO SPECIFIC ON THE DRUGS BUT IN LYMPHOMAS WE USE A DRUG CALLED RITUXAN OR RITUXIMAB THAT'S BEEN A GREAT ANTIBODY DRUG FOR OVER TWENTY YEARS BUT IT DOES SEEM TO SUPPRESS THAT ANTIBODY RESPONSE TO THE VACCINE.

I SEE.

WELL CAN YOU PROVIDE SOME STATS ABOUT BLOOD CANCER, THE SURVIVAL RATES AND THE CURE RATES AND SO FORTH?

SOME THINGS THAT WE SHOULD KEEP IN MIND.

SURE.

SO LET'S LET'S TALK ABOUT ACUTE LEUKEMIA.

THAT'S PROBABLY THE MOST IMMEDIATE IMMEDIATELY SERIOUS ONE.

THAT'S A THREAT RIGHT AWAY.

UNFORTUNATELY THERE ARE STILL PEOPLE DESPITE OUR BEST EFFORTS THAT PASS AWAY EITHER FROM RESISTANT DISEASE OR INFECTIOUS COMPLICATIONS.

I THINK WE DO A LOT BETTER JOB IN GENERAL.

OUR GOALS ARE GENERALLY CURATIVE IN THAT SITUATION, ESPECIALLY FOR THE PEOPLE THAT YOU KNOW ARE OF A REASONABLE AGE.

SOMETIMES IF SOMEBODY IN THEIR 80S OR 90S WE MAKE OTHER DECISIONS TO DO SUPPORTIVE CARE BUT ONE WAY OR THE OTHER EITHER THROUGH STANDARD THERAPY OR THROUGH ALLOGENEIC TRANSPLANT WE AIM TO TO TRY TO CURE THOSE PEOPLE.

SO THEN GETTING INTO MYELOMA WE STILL THINK OF THAT AS CHRONIC DISEASE AND A NON CURATIVE THERAPY ALTHOUGH THERE ARE SOME PEOPLE THAT CAN LIVE YEARS AND YEARS AND YEARS WITH IT AND DIE OF SOMETHING ELSE.

LIKE I SAID, THE THE AVERAGE SURVIVAL RATES ARE APPROACHING A DECADE WAS WHERE THEY WERE MUCH SHORTER A FEW YEARS AGO.

I THINK THE SAME THING IS TRUE IN ACUTE LEUKEMIA ALTHOUGH I THINK THAT'S STILL MORE SERIOUS.

WE STILL HAVE A LONG WAY TO GO IN THAT AGAIN THERE' MANY DIFFERENT TYPES OF EVEN ACUTE LEUKEMIA THAT ARE PROBABLY BEYOND THE SCOPE OF THIS DISCUSSION.

SO THAT DISCUSSION GETS A LITTLE TRICKY.

THEN WE GET TO LYMPHOMAS AND I THINK IN IN LYMPHOMAS THE THE NICE THING IS THAT WE'VE MADE ADVANCEMENTS IN THE ESPECIALLY THE LOWER GRADE LYMPHOMAS.

THESE ARE THE TYPES THAT WE THINK OF AS BEING NON CURATIVE BUT THAT YOU CAN LIVE FOR YEARS WITH AND SOMETIMES ARE JUST OBSERVED WE TREAT WHEN TREATMENT IS NECESSARY MEANING IF THEY HAVE BUT TOO MUCH LYMPH NODE ENLARGEMENT OR BLOCKAGE OF KIDNEYS OR BLOOD COUNT ABNORMALITIES.

AND SO THEN IN THAT SETTING WE'VE I THINK WE'VE MADE A LOT OF ADVANCEMENTS ESPECIALLY WITH THE NON CHEMOTHERAPEUTIC DRUGS.

OK, VERY GOOD.

DR. ROBERT MANGUS WHO'S HEMATOLOGISTS, THANK YOU SO MUCH FOR BEING ON THE PROGRAM TONIGHT.

YOU DID A GREAT JOB FOR FIRST TIME OUT.

OH THANKS.

THAT'S IT.

AND WE HOPE TO HAVE BACK THAT HALF HOUR FLIES BY DOESN'T IT?

AND WE'RE GOING TO BE BACK NEXT TUESDAY NIGHT.

IN FACT, JENNIFER BLOMQUIST WILL BE YOUR HOST.

SHE'S GOING TO BE TALKING ABOUT CANCER.

UNTIL THEN, THANK YOU FOR WATCHING.

GOOD NIGHT AND GOOD HEALTH