Leukemia rates in some Midwest states are among the highest in the country, with Minnesota ranked No. 2, Iowa No.4 and Wisconsin No.5.
In Illinois, Wisconsin, Michigan and Indiana alone, there are expected to be more than 20,000 new blood cancer cases this year and more than 6,400 deaths attributed to the disease, according to a Leukemia & Lymphoma Society report.
The good news: There’s also more help available for people with leukemia, lymphoma, multiple myeloma and other blood cancers.
“I believe that awareness of blood disorders has improved,” says Tulio Rodriguez, MD, Director of the Hematology, Bone Marrow Transplant and Cellular Therapy Program at City of Hope® Cancer Center Chicago. “With this awareness, hospital specialties that are concentrated in the management of blood disorders are also increasing in numbers. I think that overall, it reflects not only the Midwest, but also what is happening across the entire nation.”
Doctors need to pay attention to risk factors and potential signs of blood cancer and be sure they don’t overlook any clues.
Among the most common risk factors for blood cancers are:
- Age
- Tobacco use
- Exposure to radiation or certain chemicals
- Family history
“We have not found one single factor that is present in every patient with leukemia,” Dr. Rodriguez says. “The theory is that some of us, unfortunately, can have a genetic predisposition that is waiting for the attack—that insult from a pesticide, from a viral infection—and that ignites the emergence of the disease.”
Early Detection and Treatment
To better address blood cancers, patients and health care providers should be aware of the potential that some symptoms have to be early signs of leukemia, such as the tiredness associated with anemia.
“Some of these individuals with anemia, they end up having leukemia later on because it’s a diagnosis of what we call myelodysplasia, which is kind of a pre-leukemic condition that can often be missed. We take for granted that for a person who is in their 60s or 70s, being anemic is kind of expected, and as long as we manage the symptoms, that person will be OK,” Dr. Rodriguez says.
“That is a misconception,” he adds. “Some of those patients are going to develop leukemia … There have been studies where patients who are being found anemic are not necessarily receiving an intervention when the anemia is mild. If there’s some effort at a more aggressive diagnostic work-up, we will be detecting these pre-leukemic cases more often and there are medications for those conditions.”
City of Hope Cancer Center, located in Northern Illinois, has staff trained in early detection of blood cancers. For those diagnosed with blood cancers, it has a full array of treatment therapies available, including bispecific antibody therapy, CAR T-cell therapy and both autologous (from the patient) and allogeneic (from a donor) stem cell transplants.
Q&A: Addressing Blood Cancer Care in the Midwest
In this article, Dr. Rodriguez, who was recently awarded by Crain’s Chicago as a Top Leader in Health Care, answers common questions about blood cancers in the Midwest and improvements that have been made in the diagnosis and treatment of the disease. The questions he answers are:
- Could Racial Disparities Be Influencing Midwestern Blood Cancer Outcomes?
- What environmental factors in the Midwest could be contributing to higher leukemia rates?
- How does access to healthcare, including early detection and screening for leukemia, vary across different regions within the Midwest?
- How have advancements in blood cancer treatments changed outcomes for patients?
- How have these advancements affected bone marrow or stem cell transplants that are used to treat blood cancers?
- What about those who still are not eligible for a transplant?
- What can be done to ensure that these advancements are available to more patients, especially those in underserved communities?
- Why should a blood cancer patient consider City of Hope?
If you or a loved one has been diagnosed with blood cancer and are looking for a second opinion, call us 24/7 at (877) 524-4673.
Could Racial Disparities Be Influencing Midwestern Blood Cancer Outcomes?
If you think about leukemia and who is being affected the most, it often correlates with age. Populations that achieve six, seven, eight decades of life are more prone to develop these complications.
When you have concentrations of Hispanics or Latinos in certain areas like Illinois and Wisconsin — some types of leukemia are more frequently diagnosed in that population.
In diseases such as multiple myeloma, they are more frequently diagnosed in African Americans.
When you have a city or community where the representation of those minorities is higher, you’re likely going to have a higher concentration or more frequent diagnosis of multiple myeloma, leukemia, and so on.
[For example, a 2022 analysis of 822 patients in the Chicago area found that for acute myeloid leukemia (AML), “living in predominantly Black neighborhoods increases the likelihood of late-stage diagnosis and increased mortality from solid tumors.”
When compared to non-Hispanic whites, there was a 59 percent greater chance of Black people dying from AML and a 25 percent greater chance of Hispanics dying from the disease.]
What Environmental Factors in the Midwest Could be Contributing to Higher Leukemia Rates?
Determining an environmental factor might be difficult because of the way that we understand leukemia right now. You need a genetic predisposition, which in some cases can encounter a triggering factor in the environment. That explains why you have 10 people exposed to the same risk factor and maybe one or two of them are going to develop leukemia and over eight will continue completely healthy. You need to come with a genetic predisposition that responds to that factor.
How Does Access to Healthcare, Including Early Detection and Screening for Leukemia, Vary Across Different Regions Within the Midwest?
There’s some difference in access to health care based on socioeconomic factors such as ethnicity, language barriers, social determinants of health and others. These groups typically do not have as many options or access to care. That’s why they often have to go to emergency rooms for that care.
There are also some risk factors, such as obesity, that are more frequently observed in some of these minorities.
By the time they are diagnosed, in many cases, you confront diseases that are more advanced. Of course, that might have implications in regard to good outcomes.
At City of Hope, we have comprehensive blood cancer program, and we are tackling this issue from different angles. It’s not only creating programs that facilitate care for minorities or patients who we believe are affected by these barriers, but we also make efforts with our own staff to make sure they are culturally sensitive to some of the barriers this group of patients may have.
How Have Advancements in Blood Cancer Treatments Changed Outcomes for Patients?
There has been tremendous improvement in blood cancer treatment, even in leukemia. Now we have new drugs that are easier to take, easier to tolerate, and have been found to be effective, especially in those individuals that are older adults, that in the past there were no drugs that were able to treat these patients in an effective way with less side effects.
For example, we have a hypomethylating agents, like azacitidine and decitabine. There are some other drugs, BCL-2 inhibitors like venetoclax®. That combination of azacitidine and venetoclax has been a revolution in the management of patients who otherwise were not able to go through the more aggressive types of drug therapies. So, yes, we have better drugs. And we have a better understanding of the pathophysiology of the disease.
How Have These Advancements Affected Bone Marrow or Stem Cell Transplants That Are Used to Treat Blood Cancers?
We don’t want to forget that transplant has also evolved, that the stem cell therapy that we have today is not the same stem cell therapy that we had in the 60s, 70s and 80s. We have better drugs that help us take someone through a successful bone marrow transplantation.
We have better antibiotics that we didn’t have in the 80s or in the 90s that can prevent lethal complications. We can use now reduced dosages of effective chemotherapy that is used in preparation for the bone marrow or stem cell transplantation. We have better medications to prevent and manage complications.
Additionally, there’s a complication from stem cell transplantation that we call graft-vs-host-disease, and now there are better ways to prevent and manage graft-vs.-host disease, or even rejection of these cells.
When I started my training in bone marrow transplantation, 40 to 45 years old was the age limit for a transplant using stem cells from a compatible donor. With advancements in the field of stem cell transplantation, now, patients in their 70s can receive transplantation safely.
The survival of transplant patients has improved over the years. It's not only the new drugs, but also the improved understanding of prevention or mitigation of transplant-related complications that transplant physicians have developed over the years.
What About Those Who Still Are Not Eligible for a Transplant?
We have other drugs that can be used on patients who are ineligible for transplantation for whatever reason. Some of them might have a comorbidity. They could have kidney problems, for example, or they might come with a heart condition. Even for those individuals, we do have effective alternatives now.
All this should be viewed as having a full range of tools dedicated to benefiting each individual, as for example, reduced intensity therapy followed by stem cell transplantation or alternative agents for those who are not physically in good shape for standard transplantation.
The field has advanced very rapidly, giving more patients a real chance at being cured from their blood malignancies.
What Can Be Done to Ensure That These Advancements Are Available to More Patients, Especially Those in Underserved Communities?
One of the best ways of targeting disparities is through improving access to affordable health care. That is something that requires education, understanding and making sure people know that access to that type of care is available.
We have to tackle the social determinants of behavioral mental health in order to attack depression. Someone can receive the best care, but when they’re depressed, they’re less complying with medications, they don’t come so often to appointments, it affects even their outcomes. So, all these social determinants of health should be part of the comprehensive evaluation of these patients, not only the biology of an acute leukemia or any other hematologic malignancy.
Why Should a Blood Cancer Patient Consider City of Hope?
City of Hope is one of the best, worldwide-known centers for the management of hematologic malignancies and including bone marrow or stem cell transplantation. Actually, many of the discoveries that have advanced the field of hematologic oncology originated at City of Hope. Up to this day, it maintains one of the largest and most successful bone marrow transplant programs in the world.
Here in Northern Illinois, our bone marrow transplant center is a state-of-the-art facility that has all the equipment and technology that help us treat patients who are severely immunocompromised, including those undergoing transplantation. The staff is highly knowledgeable — and I’m not just talking about expert physicians in the field, but also pharmacists, and nurses specializing in bone marrow transplantation and cellular therapy.
When you come to our location for blood cancer treatment, you have a comprehensive team of professionals committed to your individual care. This comprehensive approach makes a huge difference in the treatment outcomes of patients.