Heart & Blood campaign

A SUPPLEMENT BY MEDIAPLANET DISTRIBUTED WITHIN THE INDEPENDENT March 2017 healthnews.ie prevention Dr Angie Brown

of the Irish Heart Foundation on the vital need to limit risk factors p2

hypertension Dr Catriona

Murphy on awareness, treatment and control of the ‘silent killer’ p8

blood cancer Knowing the

signs and symptoms is key to early diagnosis, and survival p10

Heart & Blood

Changing the healthcare landscape We explore the innovative treatments bringing fresh hope for those with heart or blood conditions

Photo: Jesse Orrico

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iN THIS ISSUE

New techniques Dr Martin Quinn on the groundbreaking procedure changing the landscape for aortic stenosis patients P4

Key developments Professor Michael O’Dwyer explores the exciting new therapies for blood cancer patients P10

Global events Johanna Ralston of the World Heart Federation calls on governments to increase efforts to better prevent, treat and control cardiovascular disease

Steps to a healthy heart

Although the death rate from cardiovascular disease (CVD) has reduced over the last couple of decades, there is concern that this will change, partly because people are living longer but also, unfortunately, because we are seeing increasing rates of high blood pressure, obesity and diabetes. Indeed, these risk factors for heart attack and stroke are predicted to increase significantly by 2020, says Dr Angie Brown, Medical Director, Irish Heart Foundation.

T

he good news is that nearly 80 per cent of premature CVD is preventable; lifestyle changes can have a major impact. Smoking is a major preventable cause of death. Smoking increases your pulse rate, increases your blood pressure, increases blood clotting, and damages the lining of your arteries so you’re twice as likely to get a heart attack or to suffer from a stroke. Stop smoking and you instantly cut your risk.

Keeping the amount of alcohol you drink below the recommended levels is also very important. Alcohol is high in calories so can increase your weight, and blood pressure as well as increasing triglycerides, a Follow us

fat in the blood – also risk factors for CVD. Furthermore, it can directly damage your heart and liver and increase the risk of an irregular heart rate (atrial fibrillation –AF), which in turn increases the risk of stroke.

High blood pressure and high cholesterol are risk factors that can go unnoticed. Generally, people with high blood pressure have no symptoms and we are all unaware of our cholesterol unless we get it measured. Therefore it’s important to get checked out with your GP. High blood pressure and high cholesterol are both treatable with changes to diet and exercise routines. Additionally, in many cases, medication is needed.

CVD affects women as much as men, although women tend to suffer @MediaplanetIE

heart attacks about a decade later than men, it’s equally important for women and men to take good care of themselves, live life healthily and reduce the modifiable risk factors.

Know the signs

Dr Angie Brown Medical Director, Irish Heart Foundation

@MediaplanetIE

We can’t do anything about getting older, and we can’t do anything about our genetic history – two causes of heart and blood vessel disease unrelated to lifestyle and behaviour. However, remember that if you do have a family history of CVD it’s all the more important to get a check-up.

If you think you or a loved one may be experiencing a heart attack or stroke it is vital that 999 is called, and you get to a hospital as soon as possible. The classic symptom of a heart attack is crushing

central chest pain, but pain can be in the throat, left arm or back, nausea, breathlessness and dizziness are also symptoms to look out for.

For stroke, remember the acronym FAST – face, arm, speech and time. If you notice facial asymmetry, you can’t raise your arm, or speech is slurred, then time is of the essence – call 999.

At Irish Heart, our goal is a nation living better in order to reduce premature deaths from heart disease and stroke 25 per cent by 2025 – which will require a multi pronged approach with concerted action by the government, as well as health professionals, education authorities, charities, schools and sports bodies, as well as individuals in our day-to-day lives.

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The heart of the matter How a simple test saved my life A 10-minute scan proved to David Bobbett that he was at a very high risk of a heart attack. He says the scan should be made available in accordance with medical guidelines so that those with progressive heart disease can be treated before it is too late.

I

rish entrepreneur David Bobbett was fit, well and the CEO and majority shareholder of H&K International, a successful manufacturing business that supplies stainless steel kitchen equipment to 20,000 restaurants in 80 countries around the world.

Bobbett had routine medicals every year in Ireland. He was always in the fittest 10 per cent for his age. In 2011, he had his medical in the US which included a CT scan that measured calcification in his coronary arteries.

Diagnosis and beyond The test showed he had a very high calcification score, but “The clinic didn’t say to me it was serious,” he says. “But when I did some research, I found out that it was — deadly.”

The average coronary calcification score for a person aged 50 is 15. Bobbett’s was 906, which — even though he was only in his early fifties — meant that he had the coronary arteries of an 87-year-old. “So I went to a clinic in Ireland for an angiogram which confirmed that I had one 99 per cent blocked artery and another that was 70 per cent blocked. I couldn’t understand why I had the problem.”

But a problem he most definitely had.

Bobbett was told that he had a one in four chance of a heart attack in the next four years. “I figured I was a dead man walking,” he says.

When he was diagnosed, he took six months off work, studied about 1,000 medical papers, and commissioned research to find out what could be done to prevent it.

Now he wants to make his findings public.

Calcification of the arteries is a progressive disease which results from “plaques” in the coronary arteries rupturing. Most people who have calcification don’t know they have it. “The more calcified plaque in your system, the higher your score. This accurately reflects your amount of disease activity,” says Bobbett. “So the next time you experience a rupture, it may cause a fatal blockage. Wouldn’t you want to know, and address it?”

How fatal? Well, statistics show that those with a significant calcification score

needed to. “It’s a privilege to be able to make even a slight difference” he says. ”There are a huge number of people who don’t smoke, who aren’t overweight, and who don’t have any symptoms — and they are at risk too.” He knows many who contacted the charity fitting that exact bill who lived to prevent almost-certain heart attacks after they discovered they had high scores. And unfortunately, he also knew some who didn’t get the scan before their plaques ruptured and they died.

are 8 times more likely to have a cardiac event than those with a nil score. And a third of cardiac events are fatal.

Managing the condition Bobbett didn’t need stents because his arteries had developed their own collateral supplies. And Bobbett is very clear: this is a progressive disease which can be stopped in its tracks. The vast majority of people will not get the chance to stop it, because they won’t know that they have it. To see the disease you need to get the CT scan like Bobbett did.

The answer for Bobbett was to move to a low-carb diet and start taking anti-inflammatory medications. “Excessive dietary carb was key in originally driving my disease”, he says. “For me, carbs are like pouring petrol onto a fire.” Having resolved dietary issues, “I now have a scan every two years to check my coronary calcification levels — and my disease progression has effectively stopped.” Most people though only require a once-off test.

“Like any progressive disease, the earlier you treat it, the better the outcome,” he says. “We have two choices. We can identify those at risk with a scan — because this is a condition that is measurable and it is manageable. Or we can simply wait for someone to have a cardiac event. People in Ireland die every day from heart-attacks without ever realising they had a progressive disease. With no opportunity to save themselves - which is a huge injustice.”

“The Heart of the Matter” Bobbett makes it clear that he has nothing to gain financially from promoting the CT scan. He says “it’s a simple, non-invasive test that takes around 10 minutes. And I’m talking about it because it saves lives and it should be available to men of aged 45 and over and women aged 55 and over.”

To help spread the message, Bobbett made a documentary for RTE called “The Heart of the Matter”. He also set up a charity in 2012 named Irish Heart Disease Awareness (www.ihda.ie) and made “The Widowmaker” a movie which was widely acclaimed in the US. It is now available on Vimeo.

After what happened to him, he felt he

David Bobbett Founder, Irish Heart Disease Awareness (IHDA)

“I now have a scan every two years to check my coronary calcification levels — and my disease progression has effectively stopped”

Calcification test The medical guidelines (European Guidelines on Cardiovascular Disease Prevention in Clinical Practice, version 2012) recommend the Calcification test for asymptomatic middle risk patients.

Bobbett says the calcification test is like a mammogram of the heart. Mammograms are used to identify breast cancer in women, so why isn’t the Calcification test used in accordance with the medical guidelines to identify people at risk? As the guidelines state, calcification only arises in diseased vessels – and the amount of calcium reflects the severity of disease.

At present, the scan is only available privately, at a cost of around €200 with a GP referral letter. “The trouble is there’s no money in prevention,” says Bobbett. “And also I think many people don’t realise that they can easily find out if they have the disease – and then effectively treat it. The key is to treat the disease itself, as inserting a stent doesn’t address the underlying problem. So it’s a mindset change.

Read more at www.ihda.e

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INSPIRATION

KNOW THE SYMPTOMS Knowing the signs of aortic stenosis could save your life. If you are feeling any or all of the symptoms below, it is important to seek medical advice.

Dizziness

Heart flutters

The TAVI revolution

Dr Martin Quinn, Consultant Cardiologist at St Vincent’s University Hospital, Dublin, talks about a groundbreaking procedure that has changed the landscape for aortic stenosis patients.

Healthy heart. Ne

By Ben Murnane

Chest or heart pains

Fainting

Unusual tiredness and weakness

Swollen ankles, feet or abdomen

A

ortic stenosis is a condition affecting the aortic valve in the heart, which is integral to the pumping of blood around the body. “It often affects people as they get older,” explains Quinn. “The valve becomes thickened or stenosed, obstructing bloodflow from the heart.

“Valve stenosis progresses slowly, over 10–20 years. If you get to the age of 75 and don’t have a heart murmur, it’s unlikely you’re going to get aortic stenosis. But if you have a murmur, it needs to be checked out. An examination by your doctor or an echocardiogram is usually all that’s required to evaluate whether a murmur is significant.

Dr Martin Quinn Consultant Cardiologist, St Vincent’s University Hospital, Dublin

“Sometimes, aortic stenosis doesn’t cause any symptoms and a patient presents because someone listens to their heart and hears a murmur. When it gets severe, it can cause symptoms like breathlessness, chest pain, fainting or collapsing – and is associated with an increased risk of a sudden death.”

Dr Quinn explains that younger people can be affected as well, such as those born with a bicuspid (as opposed to the normal three-leaflet or tricuspid) aortic valve. “These patients typically present in their 40s/50s/60s, whereas degenerative aortic stenosis presents in the 70s/80s/90s.”

Treatment options Until recently, the only way to replace a stenosed aortic valve was via

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“When I came out into the ward after having it done, I knew I was a changed man” Daniel Casey Patient

A happier heart

ew techniques are offering a less invasive treatment option for aortic stenosis patients Photo: jesse-orrico

open heart surgery. “This is a large, invasive operation,” says Dr Quinn. “The surgeon places the patient on a heart bypass pump, and inserts the valve through an incision in the chest wall.

“The patient goes to the intensive care unit afterwards. An older patient could spend 2–3 weeks there, and then have to go to a rehab facility.

“That was the main drive for developing TAVI (Transcatheter Aortic Valve Implantation) – to try and limit the trauma and invasiveness of the treatment.”

TAVI was a whole new way of inserting and replacing a valve, which came on stream in the early 2000s. It can be performed under conscious sedation – while the patient is awake but numbed with local anaesthetic – or under full anaesthesia.

“We insert the valve by going through a blood vessel, usually in the groin. It doesn’t

A

involve opening the chest, or major scars.

A little catheter goes in through the blood vessel. The valve is on a stent and is delivered up to the heart over a wire. The patient is usually in hospital for 48–72 hours.”

TAVI was initially trialled in high-risk patients, who were not very suitable for surgery. “More recently there have been trials done in intermediate-risk patients, which show that TAVI is actually superior to surgery in this group.”

Younger patients, however, are not good candidates for TAVI, since the type of valve inserted may not have a lifespan beyond 20 years. “If you’re under the age of 60, you will probably need a metallic valve, which can only be put in surgically.”

Nevertheless, TAVI has transformed the range of options available – and increased the likelihood of more patients leaving hospital well, and quickly.

71

-year-old Daniel Casey describes how undergoing the TAVI procedure has transformed his life.

Casey has a history of heart trouble, including having a heart attack and then a triple bypass five years ago.More recently, he was having great difficulty sleeping, in particular. “I couldn’t sleep in my bed without being propped up,” he says.

Casey was diagnosed with aortic stenosis, and told that his aortic valve would have to be replaced – either by open heart surgery or the newer TAVI procedure (Transcatheter Aortic Valve Implantation). He did not relish the thought of more procedures.

“I asked the doctor about a third option – what would happen if we did nothing? He said they would very quickly be talking to my next of kin.“My own doctor reckoned that I wouldn’t be viable for open heart surgery.” The TAVI procedure, which is far less invasive than surgery, “seemed like the best option”.

Casey had the procedure performed in Dublin.

“I trusted the doctors and the team completely – we were a team, as far as I was concerned, and I was part of it. I came in on a Sunday evening. I went into the theatre about midday on the Monday, and I went home on Thursday.”

The change Casey felt was immediate: “When I came out into the ward after having it done, I knew I was a changed man. I knew it was a success.

Straight away, I felt happy out.”

Casey has stayed well since – and has some words of advice for anyone in a similar situation.

“What I would say is, get the best possible advice, and then take that advice. Don’t dwell on any negative aspect. I don’t think about failure. If I believe in the person that I’m talking to, that they know about their job, I say, that’s good enough for me. I think it puts both of us at ease!”.

Read more patient stories at healthnews.ie

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THIS FEATURE HAS BEEN SUPPORTED BY A.MENARINI PHARMACEUTICALS IRELAND

Measure of health: How to prevent “the silent killer” The Irish Longitudinal Study on Ageing (TILDA) has found a high prevalence (64 per cent) of hypertension – a leading risk factor for cardiovascular disease – among adults aged 50 and older in Ireland, with accompanying low levels of awareness, treatment and control.

By Ben Murnane

“Over 8,500 adults aged 50 and over were randomly selected to take part in this nationwide study which collected a rich source of health, economic and social information,” says Dr Catriona Murphy, Lecturer at the School of Nursing and Human Sciences, DCU and Visiting Researcher at The Irish Longitudinal Study on Ageing, TCD. “Following an interview at home, participants were invited to take part in a health assessment either at a health centre or at home.

Blood pressure was measured twice in almost 6,000 adults aged 50 years and older; we took an average of these readings and identified those with a high reading (greater than 140/90).

“In order to estimate how common high blood pressure is in the population we included in our calculation participants with a high reading and those already on medication to lower their blood pressure. We estimated that 64 per cent of those over 50 had high blood pressure which is equivalent to 800,000 in our population.

“Of those with high blood pressure, 55 per cent were already aware they had it as they had previously been diagnosed by a doctor.

However, the remainder were unaware of this serious and silent risk factor. We found women and older people were more likely to be aware that they had high blood pressure compared to men and those in the younger age group (closer to 50 years old). We would therefore encourage younger men in particular to get their blood pressure measured, and keep a record for themselves so that

Dr Catriona Murphy Lecturer, School of Nursing and Human Sciences, DCU and The Irish Longitudinal Study of Ageing, TCD

they become familiar with their blood pressure numbers. Anyone with a high reading should be assessed by their doctor who will carry out further tests to make a formal diagnosis. Another key finding from our study was that individuals with a medical card were more likely to be on medication for high blood pressure compared to those who had to pay to visit the GP and pay the full cost of medications. This is a key finding for our policy makers if we wish to impact on the management of this condition in Ireland.”

What happened after you completed your research?

“Following the publication of our report, we linked up with nurse educators, community based nurses and the Irish Practice

“We need to raise awareness of the serious nature of high blood pressure amongst the public and amongst health professionals” Nurse Association and met with almost 400 nurses around the country in an effort to raise awareness of high blood pressure amongst nurses working in the community. The Health Research Board funded this process of engagement helping to bring the research findings to nurses in practice. We have now moved into a further phase whereby we are planning hypertension education days for nurses.”

So how can we better get the message across?

“In many cases hypertension can be prevented by keeping active, not smoking and following a healthy diet, including eating more fruits and vegetables and reducing the amount of salt we eat. We need to raise awareness of the serious nature of high blood pressure

amongst the public and amongst health professionals. We need to increase the opportunities for screening for high blood pressure and we need clear guidelines to support diagnosis and ongoing management of those with diagnosed high blood pressure.”

The Silent Killer “This is a serious risk factor; blood flows through every organ and high blood pressure can cause damage throughout the body. In most cases people have no idea that their blood pressure is high until it starts to damage organs like the heart, brain, kidneys or eyes. For this reason it has earned the title of the “Silent Killer”. The good news is that we know how to prevent high blood pressure and we know how to treat it. The challenge is for each of us to be aware of our blood pressure and to develop our health system to improve screening, diagnosis, treatment and follow up in the entire population. If we do this we can prevent a lot of the heartache that comes to individuals when they experience the complications associated with high blood pressure and we could reduce costs in our health system. We have a lot of work to do.”

Read more on healthnews.ie

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STATS

Hypertension prevalence, awareness, treatment and control in older adults in Ireland. Below are some key findings from The Irish Longitudinal Study on Ageing (TILDA).

8,500

over 50s took part in the study

64%

64%

of over 50s in Ireland have hypertension PHOTOS: THINKSTOCK

The power is yours!

By Ben Murnane Dr Robert Kelly, Consultant Cardiologist at the Beacon Hospital and RK Cardiology, discusses the importance of controlling hypertension.

even greater risk of something else happening to you. “As with so many cardiac issues, a lot of it is within your power to change.”

Medication Blood pressure is indicated by two numbers – the systolic pressure (the highest pressure when the heart beats to pump blood), and the diastolic (the lowest pressure when the heart relaxes between beats).

Hypertension, or high blood pressure, is where your number is greater than 140 over 90; either the systolic is higher than 140, the diastolic higher than 90, or both.

“Hypertension occurs in about 30–40 per cent of the population in Ireland,” explains Dr Kelly. “The number affected is higher among older individuals, but there are other contributory factors, such as being overweight, having a high-salt diet, lack of exercise, high alcohol intake.

“Hypertension plays a huge role in cardiac events, such as heart attacks and stroke. About 70 per cent of people who’ve had a stroke or a heart attack have had high blood pressure.”

Dr Robert Kelly Consultant Cardiologist, Beacon Hospital and RK Cardiology A key message is that you can significantly cut your risk by knowing your blood pressure – and, if it’s high, doing something about it. This applies even after a cardiac event.

“In the vast majority of cases, lifestyle has contributed to why someone had a heart attack. If you have high blood pressure, and you don’t change your diet and exercise routine – or take your medication, if prescribed – your blood pressure won’t be controlled, and you’ll be at an

Whether before or after a cardiac event, the challenge for doctors is often to persuade patients to adhere to advice given – in relation to lifestyle changes needed, and in relation to medication.

“In my personal practice, I meet many young patients who’ve developed high blood pressure. A lot of young patients do not want to take medicine.

“If your blood pressure is very high, you will invariably need to take medication. If it’s only a little above normal, you may not have to, once you modify your lifestyle.

Dr Kelly cautions that lifestyle is still important, regardless of whether you are prescribed medicine: “You can’t go on eating a lot of salt, drinking a lot of alcohol, taking no exercise, and just take a tablet. You’ll still be at risk for stroke and heart attacks in that case.”

Which totals around

800,000 people 55%

Only 55%

have been previously diagnosed with high blood pressure

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NEWS INSIGHT

Major discrepancies between guidelines and real life clinical practice

By Annie Hearn, Executive Director, National Institute for Preventive Cardiology (NIPC)

Despite significant advances in the medical management of cardiovascular diseases, they remain the single most common cause of death and disability in Ireland and Worldwide. The fact that an estimated 80 per cent or more of heart attacks and strokes are potentially avoidable makes a compelling case for investment in prevention.

The Heart and Stroke Charity Croi based in Galway, has been breaking new ground on the prevention landscape in Ireland by developing innovative and exemplar programmes aimed at reducing people’s risk of heart attack, stroke, diabetes and obesity. In November 2014, it launched the National Institute for Preventive Cardiology (NIPC) as an affiliate of the National University of Ireland, Galway (NUIG).

“One of the priorities of the NIPC is to ‘bridge the implementation gap’” says NIPC Executive Director, Annie Hearn. “There are globally recognised best practice guidelines for the reduction and management of cardiovascular risk. These guidelines have been developed by experts, yet there are huge discrepancies between the guidelines and real life clinical practice”.

“There are many reasons for this, including lack of resources and time pressures, but there is also a skills deficit – many healthcare professionals have not received formal training in areas such as behaviour change, which is crucial to supporting individuals wishing to change their unhealthy lifestyle behaviours. NIPC aims to address this skills deficit by providing appropriate training opportunities for healthcare professionals.” Among NIPC’s achievements to date has been the establishment of formal training in preventive healthcare through a taught Masters in Preventive Cardiology at NUIG, making it the only course of its kind in Ireland.

A series of Masterclasses are also available, which are designed and developed by the Institute faculty.

Prevention. Dr Ciara Keane talks about the importance of prevention as key to lowering heart failure deaths.

Photo: The Heartbeat Trust

Preventing heart failure: what more can be done?

Did you know…? Heart Failure affects approximately 90,000 people in Ireland, costing upwards of €700 million. One in five of us will develop heart failure in our lifetimes. These figures are staggering and more is needed to help prevent this silent killer.

By Dr Ciara Keane, Director of Operations, The Heartbeat Trust

T

he Heartbeat Trust, is Ireland’s national heart failure charity, established in 2004 by Professor Ken McDonald and Dr Mark Ledwidge to support specialist clinical and research services in heart failure and heart failure prevention. Patient services are provided in St Michael’s and St Vincent’s Hospitals – St Michael’s is also home to the STOP-HF initiative, which offers screening to prevent heart failure, a service aimed at prevention and early detection.

This prevention initiative is based on using community-based diagnostics to broaden the amount of people who can benefit from early detection. It is also based on bringing the next generation of newer, more specific treatments to the at-risk population, as well as delivering care in the community using eHealth initiatives such virtual consultations between hospitals and community care physicians.

The screening initiative is where individuals (over 40 years of age who have one cardiovascular risk factor such as high blood pressure or diabetes)

have a simple blood test which can predict those at risk of not just heart failure but other cardiovascular diseases, allowing more focused care to be directed to these at individuals.

The programme began in 2004 as a research project with the main aim of assessing if people with risk factors for heart failure could have their risk defined by the use of a blood test known as Natriuretic Peptide (NP). NP is a protein that is released from the heart when it is under stress or strain.

What could the test show?

When in the STOP-HF screening programme, a nurse takes a small blood sample to test NP levels. Higherthan-normal results suggest that a person is at risk of developing heart failure, and the level of NP in the blood is related to risk severity.

The blood test only takes a few minutes after which the results will be sent to your GP. On the day you may also have an echocardiogram (ultra sound of your heart). If the tests show high risk, there is no need to be alarmed. It is time to get proactive about your cardiac health which involves following nutrition and exercise

“Understanding if you are at risk is key to prevention and early detection, so I would encourage everyone to be proactive and get tested”

plans delivered by the expert team at The Heartbeat Trust and may involve taking certain medications to help get you back on the right path.

After the assessment, the nurse and doctor review the visit and all test results. If there are any concerns the participant will be asked to come in to the hospital to be reviewed by a doctor and have further investigations if necessary. Automatically, whether the participant is seen by a doctor or not, a letter with all investigation results is sent to their GP. All participants are educated in how best to manage their risk factors for heart failure including diet and lifestyle.

If you are a suitable candidate for the STOPHF test you will need to be referred to the STOPHF clinic by your GP. Understanding if you are at risk is key to prevention and early detection, so I would encourage everyone to be proactive and get tested. If you are a suitable candidate for the STOPHF test you will need to be referred to the STOPHF clinic by your GP.

Yours stops, hers breaks L ’s be , m

Heart disease and stroke are our greatest killers.

By volunteering for our Happy Heart Appeal, your heart can help change the lives of others.

Join us on May 12, help make life better for all of us.

www.irishheart.ie

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Blood Cancer know the signs Understanding the symptoms of blood cancer is key to early diagnosis. If you are feeling any or all of the symptoms below, it is important to seek medical advice.

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New treatments for blood cancer bring fresh hope

By Ben Murnane

Professor Michael O’Dwyer, Director of Blood Cancer Network Ireland (BCNI) and Professor of Haematology at NUI Galway, speaks about the exciting new therapies for Irish blood cancer patients.

Unexpected weight loss

Feeling weak or breathless

Enlarged lymph nodes

Fatigue

Easily bruise or bleed

Frequent and repeated infections

Approximately 10 per cent of all cancers in Ireland are blood cancers and around 1,500 people are diagnosed every year.

“One of the main blood cancers that people are familiar with is leukaemia, which is cancer of the white blood cells, involving the bone marrow, where all blood cells are produced,” says Prof O’ Dwyer. “Then there are the lymphomas – such as Hodgkin lymphoma – which involves B and T immune cells within the lymph glands; and myeloma, which is a cancer of antibody producing plasma cells.

These cancers arise from cells that originate in the bone marrow, interfering with normal blood cell production, and leading to accumulation of abnormal blood cells.

“With leukaemia, patients frequently experience tiredness because of low red blood cells (anaemia), increased susceptibility to infections, and increased risk of bleeding due to a low level of platelets. With lymphoma, patients will experience swelling of the lymph glands, often in the neck, arm or groin and sometimes fevers, abnormal sweating at night and weight loss; in multiple myeloma, patients will frequently experience fatigue and bone pain as bone destruction is common.”

Key developments

Fever/night sweats

Multiple myeloma bone pain

Read more about blood cancer online at healthnews.ie

Until recently, traditional chemotherapeutic drugs were the mainstay of treatment for blood cancers. However, in recent years there have been major advances exploiting novel therapies, such as antibodies. Access to these innovative blood cancer therapies has been greatly aided through participation in clinical trials facilitated by Cancer Trials Ireland and the BCNI. “Treatments are getting better the more we understand what makes cancer cells tick,” says Prof O’Dwyer. “However, it may take

Professor Michael O’Dwyer Director, Blood Cancer Network Ireland (BCNI) and Professor of Haematology, NUI Galway

“Treatments are getting better the more we understand what makes cancer cells tick” years before a new drug is approved and frequently the only way for patients to gain early access is via a clinical trial.

“An exciting area of blood cancer research is immunotherapy, which uses components of the immune system, such as antibodies or cells, to fight cancer. The first antibody treatment was introduced for the treatment of lymphoma about 20 years ago, but we have now gone on to find new antibodies which work particularly well in multiple myeloma.

“Another treatment that has been very important for some years, especially in the treatment of acute leukaemia, is allogeneic stem cell transplantation, where a patient receives a new bone marrow from a donor.

When bone marrow transplants were first performed, the primary intention was to replace the patient’s diseased bone marrow with a new, healthy marrow. Subsequently, it was realised that the most important part of treating leukaemia with this procedure was the introduction of a new immune system from the donor. The new donor’s immune cells can

kill leukaemia cells that have become resistant to chemotherapy and are critical to the success of allogeneic stem cell transplants.

“The downside to these types of transplants is that you require a suitably matched donor and they’re quite toxic procedures and can be risky, but what we have learned is that immune cells (T cells and NK cells) are a very powerful means of treating cancer.

“So, this was what led to an interest in using treatment based on activating or reawakening these immune cells within the patient, such as “checkpoint inhibitors” or the infusion of genetically modified activated T cells better able to seek and destroy cancer cells.

The latter is the basis of CAR-T cell immunotherapy, an exciting new area of cancer immunotherapy, whereby a patient’s own T cells are collected, genetically modified to better recognise their cancer cells and then reinfused back into to the patient.”

Moving forward

Prof O’Dwyer says that while this is a very powerful therapy and has led to dramatic response rates, at the moment there are few places actively involved in clinical trials for CAR-T cells immunotherapy.

“They’re quite complicated to conduct; there’s a lot of logistics involved in taking these cells from the patient and genetically engineering them. While the initial experience with CAR-T cell treatment has been very positive in terms of clearing the patients’ cancer, it’s not without risks. Patients can develop severe side effects, so it can only be done in places with the expertise for looking after very sick blood cancer patients on clinical trials.

“While there have been no CAR-T cell studies done to date in Ireland, we’re actively engaged in discussions with a number of companies to encourage them to bring this exciting treatment to Ireland. If they do come, it’s likely that trials will only be conducted at one or two centres nationally.

“If we can get more patients on clinical trials in Ireland, we can provide them with real hope and potentially life-saving options.”

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Changing the face of Haematology

Date of preparation: March 2017 IE/MABO/0317/0002