Back when Bloodwise was founded in 1960, there were very few treatment options available for people with blood cancer and very few people survived their cancer. In fact, the received wisdom at the time was that it was not possible to cure cancer with drugs.
Today, the picture is very different, with survival rates and outcomes for people with blood cancer dramatically improved. We look back on some of the biggest breakthroughs in blood cancer research which have led to the improved treatments and care that are available to people with blood cancer today.
In 1960, Bloodwise (then known as the Leukaemia Research Fund) was founded by Hilda and David Eastwood after they lost their six year old daughter Susan to leukaemia. They were determined to stop other families going through a similar experience and set out to support research to try and beat blood cancer.
Left - Hilda and David Eastwood counting the proceeds from their fundraising; centre - Susan in 1960; top-right - Susan with her dad; bottom right - Sylvia and her mum making handkerchiefs to raise money.
In 1965, a major piece of cancer research hypothesised that using a combination of drugs to treat cancer would make chemotherapy more effective. This is because while cancer cells could become resistant to a single drug, they would find it difficult to develop resistance to the combination of drugs.
This was successfully tested in clinical trials on children with acute lymphoblastic leukaemia, laying the foundation for modern chemotherapy treatment. Today, nearly all successful chemotherapy regimens use a combination of chemotherapy drugs.
The UK’s first bone marrow transplant
The UK’s first bone marrow transplant was performed successfully at Great Ormond Street Hospital for Children in 1979 on a child whose immune system was not working properly. This is significant because bone marrow transplants for some people who have hard to treat blood cancers, including leukaemia, lymphoma and myeloma, can lead to cures.
Stem cells are very early blood cells in the bone marrow that develop into red blood cells, white blood cells and platelets. If the DNA changes (mutates) in the stem cells that make your blood cells in your bone marrow, your blood cells might start to develop wrongly (abnormally), or fail to die when they should. These are the ‘cancerous’ or cancer cells.
Bone marrow transplants are given to people with blood cancer after they receive very high doses of chemotherapy that kills the stem cells in a person’s bone marrow, which also wipes out the cancer cells. The person then receives healthy stem cells with either cells collected from their own bone marrow or from a donor, which replaces the cells in the recipient’s bone marrow.
Bone marrow transplants are still used by the NHS today, but you’re much more likely to have a stem cell transplant than a bone marrow transplant. Stem cell transplants involve collecting stem cells from the blood rather than bone marrow and they make collecting stem cells a lot easier, and it’s less painful and invasive for the donor.
Stopping the ‘chemical messengers’ that make cancer cells grow
One of the major breakthroughs for blood cancer was the advent of targeted drugs which attack specific pathways in a cell that cause cancer. This was a huge improvement on standard chemotherapy, which just targets cells that are dividing fast, causing damage to healthy cells and unpleasant side effects.
Major groups of genes that are altered in cells affected by leukaemia are those that make proteins, called tyrosine kinases. Tyrosine kinases act as ‘chemical messengers’ which tell the cell to grow. Tyrosine kinases inhibitors (TKI) were developed to help treat some blood cancers, including chronic myeloid leukaemia (CML). The first of these was imatinib, which was introduced for treatment of CML in 1998.
TKIs target a mutated form of the tyrosine kinase protein in people with leukaemia to stop cancer cells growing and dividing. And, in some cases, the disease can be managed by just taking a daily pill.
New genetic testing has been developed to detect early signs of a potentially fatal condition that can develop into full blown leukaemia in children with Down’s syndrome. Children with Down’s syndrome are more likely to develop acute myeloid leukaemia (AML) than children without Down’s syndrome. Early intervention greatly increases chances of survival for children who develop symptoms, but there was no way of detecting those who were at risk, or clear guidelines in how to manage the AML.
Thanks to 10 years of hard research, there are clear guidelines, which recommend that all children with Down’s syndrome receive a blood test within three days of birth to identify if they are at risk. Guidelines are also now in place that make sure that children who are at risk of AML receive the specialist care and attention that is required to give them the best chances of survival.
And a groundbreaking form of cancer treatment that trains patients’ own immune cells to kill cancer cells has come a step closer to becoming available on the NHS. This was after the approval of the first two drugs of its type by the European Union’s medicines regulator.
In June 2018, the chimeric antigen receptor T-cell therapy (CAR-T) drugs Yescarta and Kymriah were recommended to be licensed by the European Medicines Agency (EMA) for the treatment of people with certain hard to treat blood cancers, including childhood leukaemia and non-Hodgkin lymphoma.
Looking to the future of NHS care
There have been huge improvements in the treatment and care of people affected by blood cancer over the last 70 years. Thanks to nurse specialists, clinicians and other NHS staff, many people are living longer than ever before. However, in order to beat blood cancer altogether, there is more still to be done.
We know that around a third of people affected by blood cancer are only diagnosed via emergency routes. We need the support of GPs and others to help spot blood cancer earlier, in order to make it easier to treat, reduce costs to the NHS and save more lives.
Landmark treatments such as CAR-T are undergoing the approval process at the moment. Although this is a potentially lifesaving treatment for small numbers of people affected by blood cancer, it’s crucial that the NHS and drug companies agree a fair price and plan sufficiently ahead to enable people to benefit from this treatment as soon as possible.
Although the NHS is getting better and better at treating blood cancer, this means that people living longer need support they’re not currently getting. More can be done to offer counselling or psychological help when people are placed on to ‘watch and wait’ pathways for their blood cancer, for example.
We’re working with the NHS to make sure that people affected by blood cancer have all of their needs supported, and live longer, in years to come.
As the NHS celebrates its milestone 70th birthday, NHS England is using each month of this year to look at one of its priority areas. Cancer will be the topic covered in August and NHS England will be looking at progress, patient and clinician experiences, as well as looking to the future of the NHS.