Dr Manasi Shah

Leukemia Leukemia is a type of cancer that starts in the blood-forming tissues, usually the bone marrow. It causes the body to overproduce abnormal white blood cells that don’t work correctly and eventually "crowd out" healthy red blood cells, normal white blood cells, and platelets. When You Should Consider Leukemia Evaluation Constant fatigue, weakness, and pale skin (Anemia). Frequent fevers, chills, or mouth sores (Infections). Easy bruising, nosebleeds, or tiny red spots on the skin called petechiae. Painless swelling of lymph nodes in the neck or armpits. An enlarged liver or spleen causing a feeling of abdominal fullness. Methods of Leukemia Classification Acute Lymphoblastic Leukemia (ALL): Progresses rapidly; most common in children but also affects adults. Acute Myeloid Leukemia (AML): Involves rapid growth of myeloid cells in both adults and children. Chronic Lymphocytic Leukemia (CLL): Most common in older adults; progresses slowly and may not require immediate treatment. Chronic Myeloid Leukemia (CML): Primarily affects adults and is often linked to the Philadelphia chromosome mutation. How Leukemia Is Managed Chemotherapy: The primary treatment using powerful drugs to kill cancer cells. Targeted Therapy: Drugs that attack specific vulnerabilities in cancer cells, often used for CML. Immunotherapy: Treatments designed to help the immune system recognize and attack leukemia cells. Stem Cell Transplant: Replacing diseased bone marrow with healthy stem cells from a donor. CAR T-cell Therapy: Re-engineering a patient's own T-cells to identify and fight the cancer. Pre-Procedure Preparation Discussing the specific type and stage of leukemia with an oncology team. Undergoing a physical exam to check for swelling in the lymph nodes, spleen, or liver. Preparing for potential hospital stays if intensive chemotherapy or transplants are required. Evaluating donor matches if a stem cell transplant is part of the treatment plan. Tests Before Leukemia Treatment Complete Blood Count (CBC): To check for abnormal levels of white cells, red cells, and platelets. Bone Marrow Biopsy: Taking a marrow sample from the hip bone for microscopic and genetic testing. Lumbar Puncture: Checking spinal fluid to see if the cancer has reached the central nervous system. Genetic Testing: Identifying specific mutations to determine the best targeted therapies. Life After Leukemia Treatment Long-term survival rates have improved to over 65% for all types combined. Children with ALL now see a cure rate of over 90%. Regular follow-up appointments are required to monitor for remission or recurrence. Ongoing management of potential side effects from intensive therapies like radiation or chemo. Benefits of Leukemia Treatment Eradicates or controls the production of abnormal "blast" cells. Restores the body's ability to produce healthy red cells, white cells, and platelets. Reduces the risk of life-threatening infections and severe bleeding episodes. Significantly increases the 5-year survival rate compared to historical outcomes.

Acute Lymphoid Leukemia (ALL) Acute Lymphoblastic Leukemia (ALL), also known as acute lymphoid or lymphocytic leukemia, is a fast-growing cancer of the blood and bone marrow. It occurs when the body overproduces immature white blood cells, called lymphoblasts, which crowd out healthy red blood cells, platelets, and normal white blood cells. When You Should Consider ALL Evaluation Persistent fatigue or weakness due to low red blood cell counts. Frequent or unexplained fevers and infections. Easy bruising, frequent nosebleeds, or tiny red spots under the skin (petechiae). Bone or joint pain caused by the buildup of lymphoblasts. Swelling in the neck, armpits, or groin (lymph nodes) or a mass in the chest. Methods of ALL Classification B-cell ALL: The most common form, accounting for about 85% of childhood cases and 75–80% of adult cases. T-cell ALL: More common in adults (25%) and often associated with a mediastinal (chest) mass. Philadelphia Chromosome-Positive (Ph+ ALL): A high-risk subtype involving a specific genetic translocation that requires specialized targeted therapy. How ALL Treatment Is Performed Induction Therapy: Intensive chemotherapy lasting 4–6 weeks aimed at killing most cancer cells to achieve remission. CNS-Directed Therapy: Intrathecal chemotherapy injected into spinal fluid to prevent cancer from hiding in the brain or spinal cord. Consolidation Therapy: High-dose therapy lasting 6–8 months to destroy any remaining "hidden" cells after remission. Maintenance Therapy: Lower-dose oral and IV drugs administered over 2–3 years to prevent the cancer from returning. Advanced Options: Includes Targeted Therapy (blocking specific enzymes), Immunotherapy (monoclonal antibodies), and CAR T-cell Therapy (genetically modified T-cells). Pre-Procedure Preparation Detailed genetic testing and chromosomal analysis to identify specific ALL subtypes like Ph+. Placement of a central venous catheter (port) to facilitate long-term chemotherapy and blood draws. Discussion of fertility preservation options before starting intensive chemotherapy or radiation. Baseline heart and lung function tests to ensure the body can tolerate intensive induction therapy. Tests Before ALL Treatment Bone Marrow Aspiration and Biopsy: To confirm the percentage of lymphoblasts in the marrow. Lumbar Puncture (Spinal Tap): To check if leukemia cells have spread to the central nervous system. Complete Blood Count (CBC): To evaluate the levels of red cells, white cells, and platelets. Flow Cytometry: To determine the exact immunophenotype (B-cell vs. T-cell) of the leukemia cells. Life After ALL Treatment Children (Ages 1–10) see the best prognosis, with 5-year survival rates exceeding 90%. Adolescents and young adults have an estimated 5-year survival rate of roughly 65–75%. Regular follow-up for 2 to 3 years is required during the maintenance phase to monitor for relapse. Long-term monitoring for "late effects" of treatment, such as cardiac issues or secondary cancers. Benefits of ALL Treatment Achieves high rates of complete remission through structured therapy phases. Prevents central nervous system involvement through proactive CNS-directed treatments. Offers curative potential for relapsed cases using modern advances like CAR T-cell therapy. Restores normal bone marrow function and healthy blood cell production.

Acute Myeloid Leukemia (AML) Acute Myeloid Leukemia (AML) is a fast-growing cancer where the bone marrow makes abnormal myeloblasts, red blood cells, or platelets. These "leukemia cells" quickly crowd out healthy cells, leading to a high risk of infection, anemia, and easy bleeding. When You Should Consider AML Evaluation Sudden bruising or tiny red spots on the skin called petechiae. Shortness of breath and extreme pale skin indicating anemia. Persistent fevers that do not respond to standard antibiotics. Evidence of high risk for infection or unexplained, easy bleeding. Methods of AML Classification FLT3 Mutation: Found in about 30% of cases and usually requires specific targeted drugs. IDH1/IDH2 Mutations: Subtypes targeted by newer oral therapies. TP53 Mutation: Often indicates a more resistant form of the disease. APL (Acute Promyelocytic Leukemia): A unique, highly curable subtype treated with non-chemo drugs like arsenic trioxide. Secondary AML: Often found in older adults (60+) arising from previous blood disorders. How AML Treatment Is Performed Induction Therapy: Typically a "7+3" regimen involving 7 days of one chemotherapy and 3 days of another to achieve complete remission. Consolidation (Post-remission): Additional chemotherapy or a Stem Cell Transplant to kill remaining microscopic cells. Targeted Therapy: Use of specific drugs for mutations like FLT3 or IDH1/IDH2. Low-Intensity Options: Use of Venetoclax pills or Hypomethylating Agents (HMA) like Azacitidine for patients who cannot handle high-dose chemo. Non-Chemo Regimens: Use of All-Trans Retinoic Acid (ATRA) specifically for the APL subtype. Pre-Procedure Preparation Cytogenetic profiling to determine the specific genetic mutations and treatment plan. Assessment of age and physical tolerance for intensive chemotherapy. Evaluation of heart or kidney function to determine if low-intensity options like Venetoclax are necessary. Screening for previous blood disorders that may lead to secondary AML. Tests Before AML Treatment Bone Marrow Analysis: To identify abnormal myeloblasts and clear the marrow of visible blasts. Genetic Testing: To check for FLT3, IDH1/IDH2, or TP53 mutations. Blood Counts: To assess the severity of anemia and low platelet levels. Cytogenetic Profiling: To map the "cytogenetic" profile which dictates the specific therapy. Life After AML Treatment For younger adults (<60), the 5-year survival rate is roughly 40% to 50%. For older adults (60+), survival is lower, typically around 10% to 20%. Patients with the APL subtype enjoy an excellent cure rate of over 90%. Ongoing monitoring is required during the consolidation phase to prevent a relapse. Benefits of AML Treatment Clears the blood and bone marrow of visible leukemia blasts. Provides "insurance" against relapse through consolidation or transplants. Offers improved survival for older patients through modern low-intensity pill combinations. Restores the production of healthy white blood cells, red cells, and platelets.

Chronic Lymphocytic Leukemia (CLL) Chronic Lymphocytic Leukemia (CLL) is the most common type of leukemia in adults. It is a slow-growing cancer of B-lymphocytes (a type of white blood cell) that originates in the bone marrow and spreads to the blood and lymph nodes. Unlike acute leukemias, many people with CLL live for years or even decades without needing immediate treatment. When You Should Consider CLL Treatment Extreme fatigue, drenching night sweats, or unexplained weight loss. Massive or painful swelling of the spleen or lymph nodes. Worsening anemia (low red cells) or thrombocytopenia (low platelets) indicating bone marrow failure. Rapid lymphocyte doubling, where the white blood cell count doubles in less than 6 months. Methods of CLL Management Active Surveillance (Watch and Wait): The standard of care for early-stage, asymptomatic patients where starting chemotherapy early has not shown to increase lifespan. BTK Inhibitors: Daily oral pills, such as Ibrutinib, Acalabrutinib, or Zanubrutinib, that block survival signals in B-cells. BCL-2 Inhibitors: Targeted drugs like Venetoclax that trigger "cell death" in leukemia cells. Monoclonal Antibodies: IV treatments like Obinutuzumab or Rituximab that "tag" cancer cells for the immune system to destroy. IVIG Infusions: Regular immunoglobulin infusions to manage high infection risks for pneumonia or shingles. How CLL Is Monitored Regular Testing: Patients typically undergo blood tests and physical exams every 3 to 6 months. Disease Progression Checks: Doctors monitor for signs of "active disease" that would necessitate a shift from surveillance to therapy. Immune System Screening: Watching for autoimmune issues where the body attacks its own red blood cells (AIHA) or platelets (ITP). Transformation Monitoring: Screening for Richter’s Transformation, where CLL evolves into an aggressive large B-cell lymphoma. Pre-Procedure Preparation Understanding the "Watch and Wait" approach and why immediate intervention is often avoided to prevent unnecessary side effects. Comprehensive baseline blood work and physical assessments to establish a comparison for future monitoring. Discussion of potential long-term risks, including a weakened immune system and increased infection susceptibility. Evaluation of age and overall health, as the average age at diagnosis is 70. Tests Before CLL Treatment Complete Blood Count (CBC): To track white blood cell doubling time and levels of red cells and platelets. Physical Examination: To check for organ issues like swelling of the spleen or lymph nodes. Genetic Testing: To determine if specific mutations are present that might respond better to targeted oral therapies. Clinical Trials Review: Assessment of trial data regarding the timing of treatment for stable patients. Life After CLL Diagnosis The overall 5-year survival rate for CLL is high, approximately 88%. Many patients live for years or decades with the disease, eventually dying from causes unrelated to leukemia. Patients must remain vigilant for complications like pneumonia, shingles, or the sudden onset of aggressive lymphoma. Ongoing active surveillance remains the primary "lifestyle" for many early-stage patients. Benefits of CLL Management Avoids the toxicity and side effects of traditional chemotherapy through targeted oral therapies. Provides a structured monitoring system to ensure treatment begins only when clinically necessary. Utilizes modern medications that are more effective and less toxic than historical options. Maintains a high quality of life for stable patients through the "Watch and Wait" strategy.

Chronic Myeloid Leukemia (CML) Chronic Myeloid Leukemia (CML) is a slow-growing cancer of the bone marrow that results in the overproduction of white blood cells. It is unique because nearly all cases (approx. 95%) are caused by a specific genetic abnormality known as the Philadelphia chromosome. When You Should Consider CML Evaluation Persistent fatigue or weakness. Drenching night sweats. Fullness or discomfort on the left side of the abdomen due to an enlarged spleen. Unexplained weight loss or mild fevers. Many patients have no symptoms and are diagnosed during routine blood tests. Methods of CML Classification Chronic Phase: The most common stage at diagnosis (85–90% of patients) where symptoms are mild and the disease responds well to standard treatment. Accelerated Phase: The cancer grows faster with blast counts rising to 10–19%, and symptoms become more noticeable. Blast Phase (Blast Crisis): An aggressive stage with 20% or more blasts that behaves like acute leukemia and is harder to treat. Genetic Cause: Driven by the BCR-ABL gene, created when pieces of chromosomes 9 and 22 swap places. How CML Treatment Is Performed TKI Therapy: Daily oral pills such as Imatinib (Gleevec), Dasatinib (Sprycel), or Nilotinib (Tasigna) that specifically "turn off" the BCR-ABL protein. Hematologic Management: Normalizing blood counts, which typically occurs within the first few weeks of treatment. Molecular Monitoring: Using sensitive PCR tests to measure and reduce the level of the BCR-ABL gene in the blood. Treatment-Free Remission (TFR): For eligible patients who maintain a deep response, stopping medication under strict medical supervision. Pre-Procedure Preparation Understanding that CML is now a manageable chronic condition requiring consistent, long-term medication. Establishing a baseline through physical exams and medical history to check for an enlarged spleen. Discussing the importance of adherence to daily oral therapy to achieve a Major Molecular Response. Planning for frequent initial monitoring to ensure the "genetic switch" is being effectively turned off. Tests Before CML Treatment Bone Marrow Biopsy: To confirm the diagnosis and determine the phase of the disease. FISH or PCR Testing: Highly sensitive blood tests used to detect the Philadelphia chromosome and the BCR-ABL gene. Complete Blood Count (CBC): To evaluate the levels of abnormal white blood cells. Cytogenetic Analysis: To identify the physical exchange of genetic material between chromosomes 9 and 22. Life After CML Treatment Life expectancy for those in the chronic phase is now approaching that of the general population. The 5-year survival rate is currently over 90%, compared to roughly 20% before the year 2000. Patients require lifelong monitoring to ensure the disease remains in molecular remission. Most patients can maintain a normal lifestyle while taking daily oral targeted therapy. Benefits of CML Treatment Revolutionizes the prognosis from a once-fatal disease to a manageable chronic condition. Specifically targets the genetic "stuck switch" (BCR-ABL) without the need for traditional intensive chemotherapy. Achieves Major Molecular Response, making the cancer gene nearly undetectable in the blood. Offers the potential for treatment-free remission in patients with deep, sustained responses.

Lymphoma Lymphoma is a cancer of the lymphatic system, which is part of the body's germ-fighting immune network. It starts in white blood cells called lymphocytes. Unlike leukemia, which is primarily in the blood and bone marrow, lymphoma often begins in the lymph nodes, spleen, thymus, or tonsils. When You Should Consider Lymphoma Evaluation Painless swelling of lymph nodes in the neck, armpit, or groin. Drenching night sweats. Unexplained fever. Sudden weight loss (more than 10% of body weight). Persistent fatigue or itchy skin. Methods of Lymphoma Classification Hodgkin Lymphoma (HL): Characterized by the presence of giant Reed-Sternberg cells; often follows a predictable path through the lymph nodes. Non-Hodgkin Lymphoma (NHL): A diverse group further divided into B-cell (85%) and T-cell lymphomas. Indolent (Slow-growing): Types such as Follicular Lymphoma where patients may live for years with minimal symptoms. Aggressive (Fast-growing): Types such as Diffuse Large B-cell Lymphoma that require immediate, intensive treatment. How Lymphoma Is Managed Chemotherapy: The primary treatment backbone for most aggressive forms of the disease. Radiation Therapy: Used to target specific areas of bulky disease. Immunotherapy: Utilizing drugs like Rituximab to help the immune system identify and kill B-cells. Targeted Therapy: Using medications that block specific growth signals within cancer cells. CAR T-cell Therapy: A cutting-edge treatment where a patient's own T-cells are reprogrammed to kill the lymphoma. Stem Cell Transplant: Often utilized if the lymphoma relapses or returns after initial treatment. Pre-Procedure Preparation Performing a physical exam to locate swollen lymph nodes, spleen, or liver. Discussing the specific subtype (indolent vs. aggressive) to determine the urgency of treatment. Preparing for a biopsy, which is the only definitive way to confirm a lymphoma diagnosis. Evaluating heart and lung function if intensive chemotherapy or a stem cell transplant is planned. Tests Before Lymphoma Treatment Lymph Node Biopsy: Surgical removal of a node or tissue sample for laboratory testing. PET and CT Scans: Advanced imaging used to determine the location and stage of the cancer. Bone Marrow Aspiration: Checking the bone marrow to see if the cancer has spread to the blood-cell "factory." Blood Tests: To assess general health and look for markers associated with certain lymphoma types. Life After Lymphoma Treatment For Hodgkin Lymphoma, the 5-year survival rate is now approximately 88%. For Non-Hodgkin Lymphoma, the 5-year survival rate is approximately 74%, varying by subtype. Regular follow-up scans and blood tests are required to monitor for remission or relapse. Many patients with indolent types can live for decades with active surveillance or periodic treatment. Benefits of Lymphoma Treatment High potential for cure, especially in Hodgkin Lymphoma and certain aggressive subtypes. Targeted therapies and immunotherapies offer effective options with fewer side effects than traditional chemo. CAR T-cell therapy provides a powerful alternative for cases that have not responded to standard care. Effectively reduces the size of bulky tumors and alleviates systemic "B symptoms" like fever and weight loss.

Hodgkin Lymphoma (HL) Hodgkin Lymphoma (HL) is a highly treatable cancer of the lymphatic system, distinguished by the presence of a specific giant cell called the Reed-Sternberg cell. It typically spreads in a predictable, orderly fashion from one group of lymph nodes to the next. When You Should Consider Hodgkin Lymphoma Evaluation Painless, firm swelling of lymph nodes in the neck, armpits, or groin. Drenching night sweats that require a change of clothes. Unexplained fevers that may come and go. Significant weight loss of more than 10% of body weight in 6 months. Rare but specific pain in the lymph nodes after consuming alcohol. Methods of Hodgkin Lymphoma Classification Classical Hodgkin Lymphoma (cHL): Accounts for about 95% of cases; includes subtypes like Nodular Sclerosis which often affects the chest and neck. Nodular Lymphocyte-Predominant (NLPHL): A rarer, slower-growing version that often requires less intensive treatment. Staging (Stages I–IV): Categorized based on whether the cancer is on one or both sides of the diaphragm. How Hodgkin Lymphoma Is Managed ABVD Chemotherapy: The "gold standard" regimen using a combination of four specific drugs (Adriamycin, Bleomycin, Vinblastine, and Dacarbazine). Radiation Therapy: Utilized as "involved-site" radiation to target specific areas of bulky disease after chemotherapy. Immunotherapy: Use of checkpoint inhibitors like Nivolumab or Pembrolizumab to help the immune system identify and kill cancer cells. Targeted Therapy: Drugs like Brentuximab Vedotin that specifically seek out the CD30 protein found on Hodgkin cells. Pre-Procedure Preparation Identifying the specific subtype through an excisional biopsy for the most accurate diagnosis. Baseline testing of heart and lung function to minimize long-term "late effects" from chemotherapy drugs. Detailed consultation for younger patients (teens to 30s) regarding fertility preservation and future health risks. Nutritional assessment to manage significant weight loss associated with "B symptoms." Tests Before Hodgkin Lymphoma Treatment Excisional Biopsy: Preferred over needle biopsies to accurately identify Reed-Sternberg cells. PET/CT Scan: Advanced imaging used to map active cancer sites and determine the stage of the disease. Blood Work: To evaluate overall health and check for inflammatory markers. Diaphragm Assessment: Imaging to determine if the cancer has crossed the muscle separating the chest and abdomen. Life After Hodgkin Lymphoma Treatment The 5-year survival rate is excellent, currently at approximately 89%. For early-stage disease, cure rates often exceed 90%. Long-term monitoring is essential to watch for second cancers or cardiovascular issues later in life. Regular follow-up appointments focus on ensuring the patient remains in remission and managing treatment side effects. Benefits of Hodgkin Lymphoma Treatment High cure rates even in advanced stages of the disease. Standardized "gold standard" regimens provide predictable and successful outcomes. Modern targeted therapies and immunotherapies reduce the need for more toxic treatments if the cancer returns. Successfully alleviates systemic symptoms such as drenching night sweats and chronic fevers.

Non-Hodgkin Lymphoma (NHL) Non-Hodgkin Lymphoma (NHL) is a diverse group of blood cancers that start in the lymphocytes (white blood cells). Unlike Hodgkin Lymphoma, NHL is much more common and behaves in a less predictable way, often appearing in multiple lymph node groups simultaneously. When You Should Consider Non-Hodgkin Lymphoma Evaluation Painless swelling of lymph nodes in the neck, armpit, or groin. Drenching night sweats. Unexplained fever and persistent fatigue. Sudden weight loss of more than 10% of body weight. Abdominal pain or swelling, which may indicate liver or spleen involvement. Methods of Non-Hodgkin Lymphoma Classification Indolent (Low-grade): Slow-growing types like Follicular Lymphoma that are manageable over many years. Aggressive (High-grade): Fast-growing types like Diffuse Large B-cell Lymphoma (DLBCL) that require immediate intensive treatment. B-cell Lymphomas: The most common category, accounting for approximately 85% of all cases. T-cell Lymphomas: A less common category, making up about 15% of cases. How Non-Hodgkin Lymphoma Is Managed R-CHOP Chemotherapy: The standard regimen for aggressive B-cell lymphomas, combining traditional chemotherapy with the antibody Rituximab. Immunotherapy: Use of bispecific antibodies like Polatuzumab or Mosunetuzumab to help the immune system target cancer cells. CAR T-cell Therapy: A revolutionary approach for relapsed cases involving the genetic re-engineering of a patient's own T-cells. Watch and Wait: Active surveillance used for slow-growing indolent types to monitor the disease before starting intervention. Targeted Therapy: Specialized drugs tailored to the specific genetic makeup of the lymphoma subtype. Pre-Procedure Preparation Determining the growth rate (indolent vs. aggressive) to establish the necessary speed of treatment. Preparing for a surgical biopsy to ensure a large enough tissue sample for accurate subtyping. Baseline cardiac and organ function testing to ensure the patient can tolerate intensive R-CHOP regimens. For CAR T-cell therapy, undergoing a process to collect T-cells from the blood for laboratory modification. Tests Before Non-Hodgkin Lymphoma Treatment Excisional Biopsy: The removal of an entire lymph node to definitively identify the specific NHL subtype. PET/CT Scan: Advanced imaging to determine the stage (I to IV) based on the location of the cancer relative to the diaphragm. Bone Marrow Biopsy: A procedure to check if the lymphoma has spread to the body's blood-producing marrow. Molecular Profiling: Testing the cancer cells for specific proteins or genetic markers to guide immunotherapy choices. Life After Non-Hodgkin Lymphoma Treatment The overall 5-year survival rate for NHL is approximately 74%, though this varies by subtype. Many patients with aggressive types achieve a total cure if they respond well to initial intensive therapy. Indolent lymphoma patients may live for many years, managing the disease as a chronic condition with periodic monitoring. Regular follow-up scans and blood work are essential to detect potential recurrence early. Benefits of Non-Hodgkin Lymphoma Treatment Offers a high chance of a total cure for many aggressive high-grade types. Effectively manages symptoms and maintains quality of life for those with slow-growing indolent types. Provides cutting-edge options like CAR T-cell therapy for patients who have relapsed after standard treatments. Utilizes targeted antibodies to increase treatment success while minimizing damage to healthy cells.