Healthy living awareness. The conversation with DKMS experts.

At Huuuge, we continuously strive to care for the well-being of our employees. February 4th marks an important occasion for all of us to stop for a minute and focus on the health and well-being of ourselves and those close to us. On World Cancer Day, we teamed up with the renowned DKMS Foundation — an international charity dedicated to the fight against blood cancer and blood disorders — to take a closer look at this one of the civilization’s diseases. Talking to Renata Rafa (DKMS Senior Communication Specialist) and Grzegorz Hensler, MD we hope to find some universal truth about cancer, while trying to answer the most pressing questions on how to stay safe and healthy.

[Huuuge]:
According to the World Health Organization, cancer is a leading cause of death worldwide and thus accounted for nearly 10 million deaths in 2020. It means this group of diseases was responsible for one in six deaths globally. How to minimize the risk of cancer? What are the basic rules of a healthy lifestyle?

[DKMS experts]:
The incidence of cancer is rising rapidly in all countries. Cancer is among the leading causes of death worldwide. There are many reasons behind this worrying trend, one of them being the unfavorable change in our lifestyle and adverse changes in our environment. Among those factors we should list tobacco smoking, obesity, changing diet patterns to processed food, lack of exercise, and forgetting your regular medical check-ups. We cannot forget the global factors such as urbanization and pollution, something each of us can and should care about. Another reason for the greater incidence of cancer is associated with increased access to better medical services and extended postreproductive life span.

There is no miraculous remedy, a pill we could take to prevent cancer or minimize the risk. But there are simple ways to significantly decrease the risk of cancer. Simple, although not always easy to implement. Maintaining a healthy diet is a great start. Avoid processed foods, high fat, and sugar intake. The correct diet should be based upon The Healthy Eating Pyramid developed by the Harvard School of Public Health.

Please note that the base of the pyramid includes regular exercise, as data has proven that regular exercise decreases the risk of cancer as well as cardiovascular diseases. Cut out the alcohol. Studies not only show that there is no safe amount of intake of alcohol, and alcohol can weaken the immune system and make the body more susceptible to infections.

STOP SMOKING! We do not need to prove this point anymore due to the countless amounts of research that has been done in the 21st century warning us about the dangers of SMOKING. Smoking is the #1 risk factor for lung cancer, but not only that! The bad news about smoking does not end there! Many other types of cancers can be caused by tobacco. Among them are head and neck cancer, laryngeal cancer, bladder cancer, pancreatic cancer, gastric cancer, colorectal cancer. The list goes on.

There are some principle rules to minimize the risk of cancer or to help diagnose it early when it is still curable. Let’s call them an oncology decalogue:

Blood cancer and how to prevent it

You represent a foundation that primarily focuses on blood cancer. What is blood cancer and what are the myths surrounding it? Is it a congenital disease?

The term blood cancer is a general description of various hematopoietic cell cancers, that is malignant diseases of bone marrow. Among those, we can list leukemias, lymphomas, multiple myeloma, MDS. In most cases, they are not congenital but are caused by a spontaneous “accidental” mutation.

Hematopoietic stem cells are known as “mother cells” and do not yet have a specific function. They can renew and differentiate into cells with a specific function, thus replacing cells that die. In the bone marrow, blood stem cells divide and develop into progenitor cells. Through further division, the progenitor cells mature and transform into different types of blood cells and then enter the bloodstream. Various factors can obstruct the normal processes of maturation, differentiation, and the natural dying of cells. This can lead to the formation of immature or abnormal blood cells, which enter the bloodstream and multiply in an uncontrolled way. These immature or abnormal cells are called cancer cells. Cancer cells flood the bloodstream and drive out healthy cells. As a result, the blood can no longer perform its basic tasks, such as transporting oxygen and protecting the body from infection.

What should be done to prevent it?

Blood cancers are rare diseases and usually the mutation that causes it is spontaneous and accidental. Apart from the oncology decalogue there are no specific ways to prevent blood cancer.

How do people with blood cancer feel? What challenges do they face in their daily lives?

The symptoms may vary depending on the disease and its aggressiveness, thus the rate of progression of symptoms. Patients with aggressive cancers such as acute leukemias, aggressive lymphomas develop symptoms quickly: malaise, fatigue, fever, night sweats, spontaneous bruising, and bleeding. In chronic diseases such as chronic lymphocytic leukemia, symptoms may not be clear and may develop over months: weight loss, bone pain, abdominal pain, malaise, headaches, recurrent infections, enlarged lymph nodes.

How can we support those suffering from that disease?

There are many ways one can support blood cancer patients: You can raise awareness of the diseases among your family and friends encouraging them not to ignore disturbing symptoms.

You can raise funds and donate them to one of many foundations supporting patients with blood cancer. You may become a volunteer in one of the clinics that take care of patients with blood cancer keeping them company, talking, bringing joy in their life. You can register as a bone marrow donor and hopefully give a second chance to a patient in need. Donate blood when possible- all patients with blood cancer need multiple blood and platelet transfusions.

Can it be cured? Is there anything each of us can do?

The prognosis depends on the diagnosis. There are blood cancers with a very good prognosis of cure exceeding 90% (for instance Hodgkin lymphoma or hairy cell leukemia). There are some (acute leukemias, some lymphomas) that are curable, but the treatment is extremely aggressive and requires months of treatment, very often with bone marrow transplantation as an option of treatment. Some blood cancers are incurable, but modern medicine with the involvement of sophisticated therapies (targeted therapies, immunotherapies) may offer a significant prolongation of life turning them into chronic diseases one lives with as with hypertension or diabetes.

What examinations should be done to detect blood cancer at an early stage?

As blood cancer is a result of a spontaneous mutation of a single cell it is hard to create a screening routine. The most reasonable advice would be not to ignore symptoms and seek advice quickly when symptoms arise. The most disturbing symptoms would be significant unexplained weight loss, fever, night sweats, spontaneous bruising and bleeding, recurrent serious infections. Routine physical check-ups and yearly blood tests (complete blood count, general urine test) seem a reasonable recommendation. When medically justified an abdominal ultrasound may be of use.

What exactly is treatment like?

Chemotherapy is the most common method of treating cancers, including hematopoietic

cancers. This type of treatment uses one or more cytostatic drugs that have a systemic effect, i.e. on the cells of the body, in particular on the cells that divide rapidly. Apart from cancer cells, during chemotherapy, other healthy cells that generally divide rapidly (bone marrow, skin cells, gastrointestinal mucosa) are also damaged. Chemotherapy, depending on the type and severity of the disease can:

• Completely cure the disease caused by neoplastic changes
• Stop the disease from progressing
• Delay the progress of the disease
• Improve the patients quality of life by alleviating some of the symptoms of the disease
• Radiotherapy is a treatment where radiation is used to kill cancer cells. It can be used to:
  1) Try to cure cancer completely (curative radiotherapy).
  2) Make other treatments more effective — for example, it can be combined.
  3) With the use of chemotherapy or used before surgery (neoadjuvant radiotherapy).
  4) Relieve symptoms if a cure is not possible (palliative radiotherapy).

Hematopoietic blood stem cell transplantation is carried out in the treatment of both cancer and non-cancer blood diseases. Hematopoietic stem cells are taken from related or unrelated donors and then given to the patient. This type of transplantation is known as allogeneic.

Auto blood stem cell transplantation, which is the administration of a patient’s cells, is also possible. Before the procedure, the patient receives intensive anticancer treatment. The patient’s hematopoietic cells can then enable the rebuilding of bone marrow and the proper blood composition to be restored.

Hematopoietic blood stem cell transplantation is a complex, multi-stage procedure. Patients stay in the hospital for up to one month, followed by further treatment that takes place at home and can last up to several months. If there are complications, all stages are longer.

This treatment modality is used to cure a list of 250 different diseases, most often however in acute leukemias, aggressive lymphomas, myelodysplastic syndromes.

The importance of donations

You invite people to become bone marrow donors. Why is it so important for your foundation? How can I become a donor? Is it dangerous?

In Poland, approximately 800 patients a year qualify for a hematopoietic stem cell or marrow transplant. The probability of finding a donor for a particular patient in need of bone marrow transplantation ranges from 1:20,000 and when the patient has rare HLA antigens (a section of DNA) it can be as high as 1: several million. When the foundation started in 2009, half of the patients qualified for bone marrow transplantation could not find their “genetic twin”, and today 80% of patients find a compatible donor.

Almost every healthy person between the ages of 18 and 55 with a BMI of less than 40 and a permanent resident of Poland can register as a potential bone marrow donor.

Anyone who would like to register can do so by ordering a registration package on our website (or other DKMS websites). The package is sent by mail and includes 3 sticks to take a swab from the inside of the cheek, a registration form, step-by-step instructions on how to register, and a return envelope. The person wishing to register takes the swab and completes the form according to the enclosed instructions and sends it back to the foundation in the return envelope.

To date, more than one million bone marrow and hematopoietic stem cell donations have been successfully performed worldwide. Doctors often emphasize that the donation procedure is safe and poses no significant threat to the health and life of the donor. Nonetheless, potential donors often face numerous concerns about whether bone marrow donation will affect their health. Marrow and hematopoietic stem cell donation is a medical procedure and, like any such procedure, can be associated with certain risks.

It has been performed around the world since the 1970s. It was then, in 1973 — the first donation was made from the hip plate. On the other hand, peripheral blood donations have been performed in medicine since 1988, and since 1996 this method has been used by DKMS.

There are two methods of collection

Stem cell collection from peripheral blood is the method used in about 90% of cases. It usually involves a one-day visit to the collection clinic and lasts between 3–5 hours. In this case, four days before the donation and on the day of the donation, the donor takes a so-called growth factor, or G-CSF, subcutaneously. It is a substance that stimulates the formation of white blood cells and causes the release of stem cells into the bloodstream, found mainly in the bone marrow. It also occurs naturally in the human body in other situations, such as during an infection. As a result, the donor may experience flu-like symptoms such as elevated temperature, bone pain, muscle aches, headaches, or a feeling of general disorientation and fatigue. These can be effectively minimized with over-the-counter pain medications such as ibuprofen or paracetamol. During the donation of hematopoietic stem cells, most donors may experience symptoms such as numbness and tingling of the tongue, lips, and fingers, and less commonly, muscle spasms.

This is the result of a temporary decrease in blood calcium levels, which quickly resolves after the administration of calcium-containing preparations. After hematopoietic stem cell donation, all blood parameters usually return to normal within 1–2 weeks and are normal in most donors at the time of the first follow-up; one month after donation. After hematopoietic stem cell donation, all blood parameters usually return to normal within 1–2 weeks and are normal in most donors at the time of the first follow-up; one month after donation. The risk of other major adverse events is marginal, and most importantly, through years of follow-up of unrelated donors undergoing G-CSF stimulation, we know that no long-term complications (e.g., increase in autoimmune diseases or cancer) are observed.

Stem cell harvesting from the hip plate is a method associated with a two to three-day stay in the hospital, due to the need for general anesthesia. The risk of life-threatening complications from general anesthesia is negligible — doctors estimate the risk to be less than 1:50,000. There is also a small risk of wound infection. After the extraction, you may experience soreness at the puncture sites for a few days, and occasionally nausea or headaches due to the arrival of general anesthesia. There are usually two small (about 5 millimeters) marks on the skin at the sites of needle insertions in the hip area, which may be tender and somewhat painful for a while, like bruises.

A typical symptom is a feeling of fatigue and decreased exercise tolerance due to red blood cell loss and anemia. These symptoms resolve within 1 to 2 weeks of collection.

Where can I go if I want to become a donor in Poland or any other country?

In Poland, you can register in the DKMS Foundation database by ordering the registration package at www.dkms.pl (or other DKMS websites) and at the same time, you can join the group of potential donors in other countries where DKMS operates, i.e. Great Britain, Germany, India, Chile, USA, South Africa.

How can each of us support the cause?

Anyone who would like to get involved in the fight against blood cancers can get involved in several ways:

• Register at www.dkms.pl (or other DKMS websites).
• Spread the word about bone marrow donation to your friends, family, and co-workers (For example, by posting educational information on your social media).
• Organize a registration event at your workplace or in your local community.
• Support the Foundation with a donation which will be used to cover the costs of recruiting potential marrow donors and support the Polish Transplant and Patient Support Program.
• Donate 1% of your tax to the Foundation.

Each donation is extremely important to us because it allows us to raise public awareness about bone marrow and blood cancer donation and to recruit new potential donors who, by donating hematopoietic stem cells or bone marrow, give patients fighting blood cancer a chance at life.