Blood Diseases Center

Keck Medicine of USC
Univeristy of Southern California
Keck Medicine of USC
Keck Medicine of USC
Keck Medicine of USC is the University of Southern California’s medical enterprise, one of only two university-owned academic medical centers in the Los Angeles area.
Blood Diseases Center2021-02-04T18:53:31+00:00

Our Program

The Blood Diseases Center at USC Norris Comprehensive Cancer Center brings leading-edge technology to the treatment and study of diseases of the blood – both malignant and non-malignant blood disorders – bone marrow and lymphatic and other related systems. We treat some of the most complex cases in the Los Angeles area, giving you the benefit of our deep experience. The USC Bone Marrow Transplant Program boasts the highest one-year survival rate in California for adult allogeneic transplants, according to the 2020 Center for International Blood and Marrow Transplant Research Report.

The USC Bone Marrow Transplant Program has been approved by Anthem Blue Cross for continued participation in their Centers of Medical Excellence network.

Our physicians stay up-to-date with research that allows them to make difficult diagnoses. Many of our physicians have been recognized as some of the Best Doctors in America. We provide specialized treatment for conditions including anemia, bleeding and clotting disorders, acute and chronic leukemia, multiple myeloma, myelodysplastic and myeloproliferative disorders, lymphomas, immune deficiencies and AIDS-associated malignancies.

The USC Blood and Marrow Transplant Program is approved by the Foundation for the Accreditation of Cellular Therapy (FACT) for both autologous (self) and allogeneic (donor) transplants. Our patients have access to one of the world’s largest registries of blood donors for potential matches through our participation in the National Marrow Donor Program. For patients without a full match, we offer transplant from haploidentical, or partial-match, donors. In addition, we are a pioneer in research on micro-transplantation, a novel treatment approach for patients with blood cancers that overcomes some of the major limitations of standard allogeneic stem cell transplantation, including Graft vs. Host Disease, a limited supply of matched donors, the need for long-term immunosuppression and toxicity from preparative regimen. Micro-transplantation also allows our patients to receive less chemotherapy and fewer immunosuppressive drugs, thus improving quality of life for patients.

In addition to our pioneering research in microtransplantation, we are conducting basic, translational and clinical research in a number of blood disorders. With an extensive portfolio of clinical trials, qualified patients can receive alternative therapies that may improve their outcomes.

Our Approach

We take a carefully balanced approach to patient care, integrating clinical research and innovative programs that emphasize maintaining your quality of life, despite having received a cancer diagnosis. We understand that each person is unique, which is why we’re dedicated to involving you in a care plan that fits your unique needs and lifestyle.

We seamlessly weave together a multidisciplinary team that treats you from diagnosis to imaging and, finally, to treatment and after-care and support. Your team meets weekly with a board of specialists who confer on your specific condition and circumstances. When you have the advantage of care from a coordinated team, you’ll receive the latest treatments, expert physicians and attention to detail that improves outcomes and reduces complications.

The center works closely with the USC Program for the Diagnosis of Rare Blood-Related Disorders, which seeks to provide answers for patients with unexplained or unusual diseases. This team comes together periodically to evaluate patients with unusual bleeding or clotting disorders, unexplained anemias or other low blood cell counts, undiagnosed diseases associated with high blood cell counts and unusual bone marrow failure syndromes.


Blood Diseases (Also called: Hematologic Diseases)

Blood is composed of different types of cells with specific functions — red blood cells take oxygen through the body, white blood cells defend against infection, and platelets help control bleeding. These cells are made in the bone marrow; so well-functioning bone marrow is also necessary for healthy blood. On average, the adult human body contains more than 5 liters of blood. Blood flows freely through the veins and arteries because it is over half liquid plasma; the remainder of blood volume consists mostly of solid cells and cell fragments, which are suspended in the plasma.

Many different types of blood conditions and blood cancers may affect patients. The most common blood disorders include anemia, bleeding and clotting disorders, and blood cancers such as acute and chronic leukemia, multiple myeloma, myelodysplastic and myeloproliferative disorders, lymphomas, immune deficiencies and AIDS-related malignancies.

Considered the most common blood disorder, anemia affects over 3 million Americans, according to the National Heart, Lung and Blood Institute. Anemia occurs when you don’t have enough red blood cells, or are destroyed too quickly. Red blood cells contain (which carry hemoglobin, an iron-rich protein that attaches to oxygen in the lungs and carries it to tissues throughout the body.) or when the red blood cells don’t function properly. Anemia is diagnosed when a blood test shows a hemoglobin value of less than 130 to 140 grams per liter (13-14 grams/deciliter) in a man or less than 120 to 130 grams per liter (12-13 grams/deciliter) in a woman.


    • When you have anemia, your body doesn’t get enough oxygen, so may experience one or more of the following symptoms:

      • Chest pain
      • Cognitive problems
      • Cold hands and feet
      • Dizziness
      • Fast or irregular heartbeat
      • Fatigue
      • Headache
      • Pale skin
      • Shortness of breath
      • Weakness

The signs and symptoms of anemia can easily be overlooked. Many people do not even realize that they have anemia until it is identified in a blood test.

People with poor diets, intestinal disorders, chronic disorders, infections, and other conditions may be at risk for anemia. Women who are menstruating or pregnant and people with chronic mental conditions are more at risk for anemia. The risk increases as people grow older. Sometimes, people who participate in vigorous athletic activities may develop anemia as a result of their red blood cells breaking down in the bloodstream.

Common Types of Anemia

Aplastic anemia is a rare form of anemia that occurs when the body stops making enough red blood cells. Causes may include viral infections, exposure to toxic chemicals, drugs, and autoimmune diseases. Idiopathic aplastic anemia is the term used when the reason for low red blood cell production is not known.

Hemolytic anemia occurs when red blood cells are broken up in the bloodstream or in the spleen. Hemolytic anemia may be due to mechanical causes (leaky heart valves or aneurysms), infections, autoimmune disorders, or congenital abnormalities in the red blood cell. Inherited abnormalities may also affect the hemoglobin or the red blood cell structure or function. Some types of thalassemia and low levels of enzymes such as glucose-6 phosphate dehydrogenase deficiency are other examples of inherited hemolytic anemias. The treatment will depend on the cause.

Iron-deficiency anemia is the most common type of anemia. It occurs when you do not have enough iron in your body. Iron deficiency is usually due to blood loss but may occasionally be due to poor absorption of iron. Pregnancy and childbirth consume a lots of iron can also can result in pregnancy-related anemia. People who have had gastric bypass surgery for weight loss or other reasons may also be iron deficient due to poor absorption.

Vitamin-deficiency anemia may result from low levels of vitamin B12 or folic acid usually because of poor dietary intake. Pernicious anemia is a condition in which vitamin B12 cannot be absorbed in the gastrointestinal tract.

Sickle cell anemia is an inherited hemolytic anemia in which the hemoglobin protein is not normal, causing the red blood cells to be rigid and clog the circulation as they are unable to flow through small blood vessels. As a result, the sickled red cells are destroyed very quickly.

Anemia caused by other diseases Some diseases can affect the body’s ability to make red blood cells. Some patients with kidney disease, for example, develop anemia because the kidneys are not making enough of the hormone erythropoietin to alert the bone marrow to make new or more red blood cells. Chemotherapy may also lead to anemia since this treatment for various cancers often impairs the body’s ability to make new red blood cells. The presence of underlying inflammatory conditions such as auto-immune conditions Rheumaoid arthritis and systemic lupus erythematosis), infections such as osteomyelitis may cause or worsen anemia.

Bleeding disorders

Bleeding disorders can occur in the presence as well as in the absence of cancer.

Platelets disorders are important causes of bleeding. Platelets are pieces of cells that act to plug up little holes in the lining of the blood vessels. Platelet disorders can be congenital (something you were born with) or something you acquire by producing too few platelets (as a result of chemotherapy or radiation) or destroying too many platelets. Also, platelets may not function properly due to a genetic loss of function or due to medications. When this happens you may experience excessive bleeding such a nose or gum bleeding, skin bruising or excessive menstrual bleeding. These disorders can be identified with proper testing.

Coagulation disorders are well-recognized causes of bleeding. These include the congenital deficiency of clotting proteins such as that seen with the Hemophilias and von Willebrands disease, or acquired deficiency due to underlying medical issues such as liver disease and medications.

Blood clots can happen under different circumstances and in many locations. Blood clots that form in response to an injury or a cut are beneficial as they stop potentially dangerous bleeding in the body. However, some conditions can cause blood clots in critical locations, such as your lungs and brain, and they require a doctor’s attention.

Blood clots may occur in both the veins and the arteries. Some form inside small veins near the surface of the skin (superficial phlebitis), and they result in localized redness, pain and swelling. Superficial phlebitis rarely causes complications and requires minimal treatment. Blood clots that form inside larger, deeper veins (deep vein thrombosis) may cause more-widespread symptoms in the affected area (usually the leg), and can cause more-serious problems.

Blood clots may also leave from their original source and cause damage elsewhere in the body. Blood clots that break away from a deep vein thrombosis and travel to your lungs may cause a potentially life-threatening blood clot in the lungs (pulmonary embolism).

Blood clots that arise in one of the chambers of the heart, usually due to an irregular heart rhythm such as atrial fibrillation, may travel to the brain and cause a stroke or to other smaller arteries to the legs arms or hands. This can block the circulation to these places. Blood clots that arise in the arteries of the heart itself may block the flow of blood through that artery and cause a heart attack.

Blood clots that arise from within the carotid arteries in the neck may travel to the brain and cause a stroke. . Blood clots can cause obstruction of arteries blocking the inflow of blood to vital organs.

Factors and conditions that can cause blood clots, as well as serious conditions that are associated with blood clots once they form and travel to other parts of your body, include:

      • Antiphospholipid syndrome
      • Arteriosclerosis / atherosclerosis
      • Certain medications, such as oral contraceptives, hormone therapy drugs and some breast cancer medications
      • Cancers Factor V Leiden
      • Family history of blood clots
      • Heart arrhythmias
      • Heart attack
      • Heart failure
      • Obesity
      • Peripheral artery disease
      • Polycythemia vera
      • Pregnancy
      • Prolonged sitting or bed rest
      • Pulmonary embolism
      • Smoking
      • Surgery

You should seek emergency care if you experience:

Shortness of breath

      • Pressure, fullness or a squeezing pain in the center of your chest lasting more than a few minutes
      • Pain extending to your shoulder, arm, back or jaw
      • A fast heartbeat
      • Sudden weakness or numbness of your face, arm or leg
      • Sudden difficulty speaking or understanding speech (aphasia)
      • Sudden blurred, double or decreased vision

You can reduce the risk of developing blood clots by following these tips:

    • Avoid sitting for long periods. If you travel by airplane, walk the aisle periodically. For car trips, stop and walk around frequently.
    • Move. After you’ve had surgery or been on bed rest, it’s best to move as soon as you can.
    • Change your lifestyle. Losing weight, lowering high blood pressure, exercising regularly and stopping smoking are also good ways to lower the risk.

Blood cancers
Blood cancer is an umbrella term for malignancies of the blood, bone marrow or lymph nodes that affect normal blood cell production or function. As these diseased cells proliferate in the body, they cause life-threatening damage to the immune and circulatory systems.

Leukemia usually involves the white blood cells, which are potent infection fighters and normally grow and divide in an orderly way, as the needs of the body demand. But in people with leukemia, the bone marrow produces abnormal white blood cells, which don’t function properly. Some forms of leukemia are more common in children, while others are only seen in adults.


    Make sure you make an appointment with a doctor if you see any persistent signs and symptoms such as:

    • Bone pain or tenderness
    • Easy bleeding or bruising
    • Excessive sweating, especially at night
    • Fever or chills
    • Frequent or severe infections
    • Losing weight without trying
    • Persistent fatigue, weakness
    • Recurrent nosebleeds
    • Swollen lymph nodes, enlarged liver or spleen
    • Tiny red spots in your skin (petechiae)

Multiple Myeloma
Multiple myeloma is a cancer that forms in plasma cells. Plasma cells are a type of white blood cells that help fight infections by making antibodies that recognize and attack germs. Multiple myeloma causes cancer cells to collect in the bone marrow, where they crowd out healthy blood cells. Rather than produce helpful antibodies, the cancer cells produce abnormal proteins that can cause kidney problems.

Treatment for multiple myeloma isn’t always necessary. If you’re not experiencing signs and symptoms, you may not require treatment. If signs and symptoms develop, a number of treatments can help control your multiple myeloma.


    Signs and symptoms of multiple myeloma can vary and, early in the disease, there may be none. They may include:

    • Bone pain, especially in your spine or chest
    • Constipation
    • Excessive thirst
    • Fatigue
    • Frequent infections
    • Loss of appetite
    • Mental fogginess or confusion
    • Nausea
    • Weakness or numbness in your legs
    • Weight loss

Lymphoma is a cancer of the body’s disease-fighting network (the lymphatic system). The lymphatic system includes the lymph nodes (lymph glands), spleen, thymus gland and bone marrow. Lymphoma can affect all those areas as well as other organs throughout the body.

The main categories of lymphoma are:
• Hodgkin’s lymphoma
• Non-Hodgkin’s lymphoma

The type of lymphoma treatment that is best for you depends on your lymphoma type, the severity of your lymphoma and your preferences. Lymphoma treatment may involve chemotherapy, biological therapy medications, radiation therapy or a stem cell transplant.

Non-Hodgkin’s lymphoma (also called non-Hodgkin lymphoma) is a cancer that originates in the lymphatic system, the disease-fighting network spread throughout your body. In non-Hodgkin’s lymphoma, tumors develop from — a type of white blood cell called lymphocytes. Non-Hodgkin’s lymphoma is more common than the other general type of lymphoma — Hodgkin lymphoma. The most common non-Hodgkin’s lymphoma subtypes include diffuse large B-cell lymphoma and follicular lymphoma.


    Non-Hodgkin’s lymphoma symptoms may include:

    • Abdominal pain or swelling
    • Chest pain, coughing or trouble breathing
    • Fatigue
    • Fever
    • Night sweats
    • Painless, swollen lymph nodes in your neck, armpits or groin
    • Weight loss

Hodgkin’s lymphoma
Hodgkin’s lymphoma (formerly known as Hodgkin’s disease) is a cancer of the lymphatic system, which is part of your immune system. In Hodgkin’s lymphoma, cells in the lymphatic system grow abnormally and may spread beyond the lymphatic system. As Hodgkin’s lymphoma progresses, it compromises your body’s ability to fight infection.

Hodgkin’s lymphoma is one of two common types of cancers of the lymphatic system. The other type, non-Hodgkin’s lymphoma, is far more common.
Advances in diagnosis and treatment of Hodgkin’s lymphoma have helped give people with this diagnosis the chance for a full recovery. The prognosis continues to improve for people with Hodgkin’s lymphoma.


Hodgkin’s lymphoma signs and symptoms may include:

    • Fever and chills
    • Increased sensitivity to the effects of alcohol or pain in your lymph nodes after drinking alcohol
    • Itching
    • Loss of appetite
    • Night sweats
    • Painless swelling of lymph nodes in your neck, armpits or groin
    • Persistent fatigue
    • Unexplained weight loss — as much as 10 percent or more of your body weight

Myelodysplatic disorders
Myelodysplastic syndromes are a group of disorders caused by poorly formed or dysfunctional blood cells. Myelodysplastic disorders occur when something goes wrong in the bone marrow (the spongy material inside your bones where blood cells are made).

Doctors divide myelodysplastic syndromes into two categories based on their cause:

  • Myelodysplastic syndromes with no known cause are called de novo myelodysplastic syndromes; doctors don’t know what causes these. De novo myelodysplastic syndromes are often more easily treated than are myelodysplastic syndromes with a known cause.
  • Myelodysplastic syndromes caused by chemicals and radiation occur in response to cancer treatments, such as chemotherapy and radiation, or in response to chemical exposure are called secondary myelodysplastic syndromes. Secondary myelodysplastic syndromes are often more difficult to treat.


Myelodysplastic syndromes rarely cause signs or symptoms in the early stages of the disease. Hoever, in time, myelodysplastic syndromes may cause:

    • Easy or unusual bruising or bleeding
    • Fatigue
    • Frequent infections
    • Pinpoint-sized red spots just beneath your skin caused by bleeding (petechiae)
    • Shortness of breath
    • Unusual paleness (pallor) due to anemia

Myelofibrosis is a serious bone marrow disorder that disrupts the body’s normal production of blood cells. It can result in extensive scarring in your bone marrow, leading to severe anemia, weakness, fatigue, and often, an enlarged spleen and liver. Myelofibrosis is part of a group of diseases known as myeloproliferative disorders.
Many people with myelofibrosis get progressively worse, and some may eventually develop a more serious form of leukemia. However, it is also possible to have myelofibrosis and live symptom-free for years.


    Myelofibrosis often develops slowly. In its very early stages, many people don’t experience signs or symptoms. But as disruption of normal blood cell production increases, signs and symptoms may include:

    • Bone pain
    • Easy bleeding
    • Easy bruising
    • Excessive sweating during sleep (night sweats)
    • Feeling tired, weak or short of breath, usually because of anemia
    • Fever
    • Frequent infections
    • Pain or fullness below your ribs on the left side, due to an enlarged spleen
    • Pale skin


The Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases at USC Norris Comprehensive Cancer Center offers a broad range of services to treat all kinds of blood cancers and non-cancerous blood disorders such as anemia, bleeding and clotting disorders. The center’s team of highly qualified experts is widely regarded for its expertise in treating patients with all forms of leukemia, and in particular acute lymphocytic leukemia.

USC Norris’ well-known bone marrow transplant program offers both autologous and allogenic bone marrow transplant available for both blood cancers as well as non-cancerous conditions. The USC Bone Marrow Transplant Program boasts the highest one-year survival rate in California for adult allogeneic transplants, according to 2011-2013 data on Our outcomes are among the top 10 bone marrow transplant programs in the country, among centers that perform at least 10 transplants a year. The program also offers haploidentical transplants, which allow patients who can only find partially matching donors to receive potentially life-saving bone marrow transplants. The Center is also a national leader in a new form of bone marrow transplant (microtransplantation), which involves a less intense form of chemotherapy. This treatment also doesn’t involve the use of immunosuppressive drugs after the transplant so the risk of infection is much lower than others.

Our program has been designated as a “MDS Center of Excellence.” Active research is currently being pursued in the areas of targeted therapies, chimeric antigen receptors, and monoclonal antibodies for the treatment of blood disorders. Our staff also includes some of the top experts and researchers in the diagnosis and management of bleeding and clotting disorders nationwide. A number of our physicians have received “Southern California Top Doctor” and “Pasadena Top Doctor” citations. The Center offers a large number of clinical trials available for both blood cancers and non-cancerous blood disorders. Finally, USC Norris is a comprehensive cancer center, offering all the latest technological platforms and cutting-edge tools—including PET scans, CT scans and access to the latest genomic profiling options.

In addition, the Jane Anne Nohl Division of Hematology and the Center for Blood disorders has physicians who are expert in treating non-malignant disorders of the blood such as blood clots, aplastic anemia, hemoglobinopathies, bleeding disorders and a variety hemolytic anemias, immune cytopenias. We have research studies looking both at the pathophysiology and treatment of these disorders. Our physicians are among the world’s experts at diagnosing and treating bleeding and clotting disorders.


The treatment of anemia is dependent on its cause:

Anemia of chronic diseases
There is no specific treatment for this type of anemia so doctors often focus on treating the underlying disease. If it worsens, the doctor may suggest a blood transfusion or injections of synthetic erythropoietin, a hormone normally produced by your kidneys, may help stimulate red blood cell production and ease fatigue.

Anemias associated with bone marrow disease
Treatment can include simple medication, chemotherapy or bone marrow transplantation.

Aplastic anemia
The treatment for this anemia may include blood transfusions to increase levels of red blood cells. You may need medication to suppress your immune system or an allogenic bone marrow transplant if your bone marrow is diseased and can’t make healthy blood cells.

Hemolytic anemias
Treatment includes avoiding suspect medications, treating related infections and taking drugs that suppress your immune system, which may be attacking your red blood cells. Depending on the severity of your anemia, a blood transfusion may be necessary. Plasmapheresis is a type of blood-filtering procedure. Sometimes, removal of the spleen may also be recommended.

Iron deficiency anemia
This type of anemia is treated with changes in diet and iron supplements.
If the underlying cause of iron deficiency is loss of blood (other than from menstruation) the source of the bleeding must be located and stopped. This may involve surgery.

Sickle cell anemia
Treatment for this anemia may include the administration of oxygen, pain-relieving drugs, and oral and intravenous fluids to reduce pain and prevent complications. Blood transfusions, folic acid supplements and antibiotics can also be recommended. In some cases, a bone marrow transplant may be an effective treatment. A cancer drug called hydroxyurea (Droxia, Hydrea) is also used to battle sickle cell anemia.

This may be treated with blood transfusions, folic acid supplements, removal of the spleen (splenectomy), a bone marrow transplant or another drug.
People with thalassemia trait may have only mild anemia or small red blood cells and no treatment is required. However, they may be advised to avoid iron supplementation.

Vitamin deficiency anemias such as Folic acid and vitamin B-12 deficiency anemias are treated with dietary supplements and increasing these nutrients in your diet. If your digestive system has trouble absorbing vitamin B-12 from the food you eat, you may receive vitamin B-12 injections.


Treatment for leukemia depends on various factors. Your options vary based on your age and overall health, the type of leukemia you have, and whether it has spread to other parts of your body.

Common treatments for leukemia include:

Biological therapy works by using treatments that help your immune system recognize and attack leukemia cells.

Chemotherapy is a drug treatment, which uses chemicals to kill malignant cells, is the leading form of treatment for leukemia. Depending on the type of leukemia you have, you may receive a single drug or a combination of drugs. These drugs may come in a pill form, or they may be injected directly into a vein.

Radiation therapy uses X-rays or other high-energy beams to damage leukemia cells and stop their growth. During radiation therapy, the patient lies on a table while a large machine moves around them, directing the radiation to precise points on the body. You may receive radiation in one specific area of your body where there is a collection of leukemia cells, or you may receive radiation over your whole body. Radiation therapy may be used to prepare for a stem cell transplant.

Stem cell transplant procedures replace your diseased bone marrow with healthy bone marrow. Before the transplant, you will receive high doses of chemotherapy or radiation therapy or both to destroy your diseased bone marrow. Then you receive an infusion of blood-forming stem cells that help to rebuild your bone marrow. You may receive stem cells from a donor, or in rare cases you may be able to use your own stem cells. A stem cell transplant is very similar to a bone marrow transplant. In select cases, Doctors may use a reduced-intensity stem cells transplant may be offered to certain patients, such as older patients who are less likely to tolerate stronger chemotherapy or radiation doses used.

Targeted therapy uses drugs that attack specific vulnerabilities within your cancer cells. The drug imatinib (Gleevac), for example, is used to stop the action of a protein within the leukemia cells of people with chronic myelogenous leukemia. This helps control the disease.

Multiple Myeloma
If you’re experiencing symptoms of multiple myeloma, treatment can help relieve pain, control complications of the disease, stabilize your condition and slow the progress of the disease.

If you have multiple myeloma but aren’t experiencing any symptoms (smoldering multiple myeloma), you may not need treatment. However, your doctor will regularly monitor your condition for signs the disease is progressing. This may involve periodic blood and urine tests. If you develop signs and symptoms or your multiple myeloma shows signs of progression, you and your doctor may decide to begin treatment.

Although there’s no cure for multiple myeloma, you can usually return to near-normal activity once you receive good treatment results. Standard options include:

Biological therapy uses your body’s immune system to fight myeloma cells. The drugs thalidomide (Thalomid), lenalidomide (Revlimid) and pomalidomide (Pomalyst) aid the immune system cells that identify and attack cancer cells. These medications are taken in pill form.

Chemotherapy drugs kill fast-growing cells, including myeloma cells. Chemotherapy drugs can be given through a vein in your arm or taken in pill form. High doses of chemotherapy drugs are used before a stem cell transplant.

Corticosteroids such as prednisone and dexamethasone, which regulate the immune system to control inflammation in the body, are also active against myeloma cells. Corticosteroids can be taken in pill form or administered through a vein in your arm.

Radiation therapy uses beams of energy, such as X-rays, to damage myeloma cells and stop their growth. Radiation therapy may be used to quickly shrink myeloma cells in a specific area that’s causing pain or destroying a bone.

Stem cell transplantation replaces your diseased bone marrow with healthy bone marrow. Before a stem cell transplant, blood-forming stem cells are collected from your blood, and you will receive high doses of chemotherapy to destroy your diseased bone marrow. Then your stem cells are infused into your body, where they travel to your bones and begin rebuilding the bone marrow.

Targeted therapy drugs like Bortezomib (Velcade) and carfilzomib (Kyprolis) are targeted drugs that block the action of a substance in myeloma cells that breaks down proteins. These targeted drug treatments focus on specific abnormalities within cancer cells that allow them to survive. This action causes myeloma cells to die. Both medications are administered through a vein in your arm.

The combination of treatments you’re likely to receive will depend on whether you’re considered a good candidate for stem cell transplant. This depends on the risk of the disease progressing, your age and your overall health.

If you’re considered a candidate for stem cell transplant, your initial therapy will likely include a combination of treatments, such as targeted therapy, biological therapy, corticosteroids and, sometimes, chemotherapy.

Your stem cells will likely be collected after you’ve undergone a few months of treatment. You may undergo the stem cell transplant soon after your cells are collected or the transplant may be delayed until after a relapse, if it occurs. In some cases, doctors recommend two stem cell transplants for people with multiple myeloma. After your stem cell transplant, you’ll likely receive targeted therapy or biological therapy as a maintenance treatment to prevent a recurrence of myeloma.

If you’re not considered a candidate for stem cell transplant, your initial therapy will likely include chemotherapy combined with corticosteroids, targeted therapy or biological therapy.

If your myeloma recurs or doesn’t respond to treatment, your doctor may recommend repeating another course of the treatment that initially helped you. Another option is trying one or more of the other treatments typically used as first line therapy, either alone or in combination. Research on a number of new treatment options is ongoing, and you may be eligible for a clinical trial in order to gain access to those experimental treatments. Talk to your doctor about what clinical trials may be available to you.

Because multiple myeloma can cause a number of complications, you may also need treatment for specific conditions.

    • Anemia: If you have persistent anemia, your doctor may recommend medications to increase your red blood cell count.
    • Bone loss: Medications called bisphosphonates, such as pamidronate (Aredia) or zoledronic acid (Zometa), may be advised by your doctor to help prevent bone loss.
    • Bone pain: Pain medications, radiation therapy and surgery may help control bone pain.
    • Infections: Certain vaccines to prevent infections, such as the flu and pneumonia, may be recommended by your doctor.
    • Kidney complications: People with severe kidney damage may need dialysis.

Your treatment options are determined based on the type and stage of your lymphoma, your age, and your overall health. However, please note that the treatment isn’t always necessary. If your lymphoma appears to be slow growing (indolent), a wait-and-see approach may be an option. Indolent lymphomas that don’t cause signs and symptoms may not require treatment for years. Your doctor will likely schedule regular checkups every few months to monitor your condition and ensure that your cancer isn’t advancing.

If your non-Hodgkin’s lymphoma is aggressive or causes signs and symptoms, your doctor may recommend treatment. Options may include:

  • Chemotherapy is a drug treatment (given orally or by injection) that kills cancer cells. Chemotherapy drugs can be given alone, in combination with other chemotherapy drugs or combined with other treatments.
  • Medications that deliver radiation directly to cancer cells: Radioimmunotherapy drugs are made of monoclonal antibodies that carry radioactive isotopes. This allows the antibody to attach to cancer cells and deliver radiation directly to the cells. Ibritumomab tiuxetan (Zevalin) — is used to treat lymphoma.
  • Medications that enhance your immune system’s ability to fight cancer: Biological therapy drugs help your body’s immune system fight cancer.
    For example, one biological therapy called rituximab (Rituxan) is a type of monoclonal antibody that attaches to B cells and makes them more visible to the immune system, which can then attack. Rituximab lowers the number of B cells, including your healthy B cells, but your body produces new healthy B cells to replace these. The cancerous B cells are less likely to return.
  • Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancerous cells and shrink tumors. During radiation therapy, you’re positioned on a table and a large machine directs radiation at precise points on your body. Radiation therapy can be used alone or in combination with other cancer treatments.
  • Photopheresis, or extracorporeal photopheresis (ECP), is a palliative treatment for cutaneous T-cell lymphoma offered by Keck Medical Center of USC, in which blood is treated with a photosensitizing agent and a specific type of light. This procedure involves drawing and separating a patient’s blood cells into components and collecting the white blood cells (WBCs) through a vein or central line. A cell separation machine mixes the WBCs with the drug UVADEX, or methoxsalen. The mixture is then exposed to ultraviolet A-light, and the treated cells are re-infused into the body.
  • Stem cell transplant is a procedure that involves very high doses of chemotherapy or radiation to destroy the lymphoma cells that may not be killed with standard doses. Later, healthy stem cells (your own or from a donor) are injected into your body, where they can form new healthy blood cells.

Hodgkin’s Lymphoma

The kind of treatment options appropriate for your Hodgkin’s lymphoma depends on your type and stage of disease, your overall health, and your preferences. The goal of treatment is to destroy as many cancer cells as possible and bring the disease into remission.

Chemotherapy is a drug treatment that uses chemicals to kill lymphoma cells. The drugs travel through your bloodstream and can reach nearly all areas of your body. The treatment is often combined with radiation therapy in people with early-stage classical type Hodgkin’s lymphoma. Radiation therapy is typically done after chemotherapy. In advanced Hodgkin’s lymphoma, chemotherapy may be used alone or combined with radiation therapy.

Chemotherapy drugs can be taken in pill form, through a vein in your arm or sometimes both methods of administration are used. Several combinations of chemotherapy drugs are used to treat Hodgkin’s lymphoma.

Side effects of chemotherapy depend on the specific drugs you’re given. Common side effects include nausea and hair loss. Serious long-term complications can occur, such as heart damage, lung damage, fertility problems and other cancers, such as leukemia.

Radiation therapy uses high-energy beams, such as X-rays, to kill cancer cells. For classical Hodgkin’s lymphoma, radiation therapy can be used alone, but it is often used after chemotherapy. People with early-stage lymphocyte-predominant Hodgkin’s lymphoma typically undergo radiation therapy alone. During radiation therapy, you lie on a table and a large machine moves around you, directing the energy beams to specific points on your body. Radiation can be aimed at affected lymph nodes and the nearby area of nodes where the disease might progress. The length of radiation treatment varies, depending on the stage of the disease.

Radiation therapy can cause skin redness and hair loss at the site where the radiation is aimed. Many people experience fatigue during radiation therapy. More-serious risks include heart disease, stroke, thyroid problems, infertility and other forms of cancer, such as breast or lung cancer.

Stem cell transplant replaces the diseased bone marrow with healthy stem cells that help grow new bone marrow. A stem cell transplant can be an option if Hodgkin’s lymphoma returns despite treatment. During a stem cell transplant, your own blood stem cells are removed, frozen and stored for later use. Then, you will receive high-dose chemotherapy and radiation therapy to destroy cancerous cells in your body. Finally your stem cells are thawed and injected into your body through your veins. The stem cells help build healthy bone marrow.

Myelodysplastic Disorders Treatments

Treatment for myelodysplastic disorders often involves steps taken to slow the progression of the disease and supportive care to help manage symptoms such as fatigue and to prevent bleeding and infections.

Blood transfusions can be used to replace red blood cells, white blood cells or platelets in people with myelodysplastic syndromes. In very rare cases, white blood cells may also be infused but these cells are very short-lived so their benefit is unproven and they may cause more significant infusion reactions.

Medications used to increase the number of healthy blood cells your body produces include:

      • Medications that increase the number of blood cells your body makes, which are called growth factors, these medications are artificial versions of substances found naturally in your bone marrow. Some growth factors, such as epoetin alfa (Epogen) or darbepoetin alfa (Aranesp), can reduce the need for blood transfusions by increasing red blood cells. Others may help prevent infections by increasing white blood cells in people with certain myelodysplastic syndromes.
      • Medications that stimulate blood cells to mature, rather than remain immature such as azacitidine (Vidaza) and decitabine (Dacogen) may improve the quality of life of people with certain myelodysplastic syndromes and reduce the risk of acute myelogenous leukemia.
      • Medications that suppress your immune system may be used in certain myelodysplastic syndromes.
      • Medication for people with a certain genetic abnormality are sometimes available such as lenalidomide (Revlimid) for patients with deletion of chromosome 5q (sometimes called “5q minus syndrome) . Lenalidomide may reduce the need for blood transfusions in people with this gene mutation.

Bone marrow stem cell transplants take your defective blood cells, which are damaged using chemotherapy drugs, and replace them with healthy, donated cells (allogeneic transplant). Most bone marrow stem cell transplants used to treat myelodysplastic syndromes are reduced-intensity or “mini” transplants. This means the chemotherapy drugs used before the transplant are less powerful than those used in standard transplants and are likely to cause fewer side effects. However, even reduced-intensity transplants carry a significant risk of side effects. That’s why not everyone people with myelodysplastic syndromes is a candidate for bone marrow/stem cell transplant.


If you aren’t experiencing symptoms and don’t show signs of anemia, an enlarged spleen or other complications, treatment usually isn’t necessary. Instead, your doctor is likely to monitor your health closely through regular checkups and exams, watching for any signs of disease progression. Some people remain symptom-free for years.

Treatments that target gene mutations

Researchers are working to develop medications that target the JAK2 gene mutation that’s thought to be responsible for myelofibrosis. These medications, such as Ruxolitinib have been helpful in decreasing enlarged spleens and reducing symptoms associated with myelofibrosis. It’s not yet clear whether these medications can help people with myelofibrosis live longer. But preliminary indications from clinical trials show promise.

Ruxolitinib works by stopping the action of all JAK-related genes in the body, including those found in both healthy and diseased cells. Because healthy cells are affected, side effects may occur, such as bleeding, infection, bruising, dizziness, anemia and headaches.

Treatments for anemia

If myelofibrosis is causing severe anemia, you may consider treatment, such as:

      • Androgen therapy takes a synthetic version of the male hormone androgen may promote red blood cell production and may improve severe anemia in some people. Androgen therapy does have risks, including liver damage and masculinizing effects in women.
      • Blood transfusions can increase your red blood cell count and ease anemia symptoms, such as fatigue and weakness. Sometimes, medications can help improve anemia.
      • Thalidomide and related medications (Thalomid) and the related drug lenalidomide (Revlimid) may help improve blood cell counts and may also relieve an enlarged spleen. These drugs may be combined with steroid medications. Thalidomide and related drugs carry a risk of serious birth defects and require special precautions. This type of treatment is being studied in clinical trials.

Treatments for enlarged spleen

If an enlarged spleen is causing complications, your doctor may recommend:

      • Chemotherapy drugs may reduce the size of an enlarged spleen and relieve related symptoms, such as pain.
      • Radiation therapy uses high-powered beams, such as X-rays, to kill cells. Radiation therapy can help reduce the size of the spleen, when surgical removal isn’t an option.
      • Stem cell transplant from a suitable donor (also known as allogeneic stem cell transplantation) is the only treatment that has the potential to cure myelofibrosis. However, it also has a high risk of life-threatening side effects. Most people with myelofibrosis do not qualify for this treatment because of age, stability of the disease or other health problems. Prior to a stem cell transplant, also called a bone marrow transplant, you receive very high doses of chemotherapy or radiation therapy to destroy your diseased bone marrow. Then you receive infusions of stem cells from a compatible donor. After the procedure, there’s a risk that the new stem cells will react against your body’s healthy tissues, causing potentially fatal damage. Other risks include organ or blood vessel damage, cataracts, and the development of a different cancer later on. Doctors are studying a reduced-intensity transplant (also known as nonmyeloablative transplant or minitransplant), which uses lower doses of pre-transplant chemotherapy and radiation. Although reduced-intensity transplantation has side effects, it is hoped that it will one day be a safer option for older patients.
      • Surgical removal of the spleen (splenectomy) – If your spleen becomes so large that it causes pain and begins to lead to harmful complications, and you don’t respond to other forms of therapy, you may benefit from having your spleen surgically removed. Risks include infection, excessive bleeding and blood clot formation leading to stroke or pulmonary embolism. After the procedure, some people experience liver enlargement and an abnormal increase in platelet count.

Finally, clinical trials are underway to test several new and promising agents for patients with myelofibrosis. Check with your hematologist to find out if you might be a candidate for a clinical trial.


California Dept. of Public Health’s Anemia page

Patient Group Resources from the American Society of Hematology

National Institute of Health’s Guide to Anemia

Lymphoma Support Network

CancerCare’s Lymphoma Support Program

Leukemia and Lymphoma Society’s Support & Resources

Leukemia Support Groups

The Leukemia and Lymphoma Society’s Support Page

Acute Myleogenous Leukemia Support Group

Multiple Myeloma Research Center’s Support Page

American Cancer Society’s Multiple Myeloma Page

Life with Multiple Myeloma’s Support Page

Our Physicians

Greg R. Angstreichview profile

Practicing Locations

USC Norris Oncology/Hematology Newport Beach
USC Norris Treatment Center Newport Beach
Leslie Ballasview profile

Practicing Locations

Keck Medicine of USC - Pasadena
USC Norris Comprehensive Cancer Center

Specializing In

Hematologic Malignancies, Leukemia, Lymphomas, Multiple Myeloma, Prostate Cancer, Genitourinary Cancers, and Melanomas

Preet M. Chaudharyview profile

Practicing Locations

USC Norris Comprehensive Cancer Center

Specializing In

Acute Leukemias, Lymphomas, Allogeneic Bone Marrow Transplant

Kevin Kellyview profile

Practicing Locations

LAC+USC Medical Center
USC Norris Comprehensive Cancer Center

Specializing In

Leukemia, Myeloma, Lymphoma

Howard A. Liebmanview profile

Practicing Locations

USC Norris Comprehensive Cancer Center

Specializing In

Thrombotic and Bleeding Disorders, Immune Blood Disorders, Bone Marrow Failure Syndromes

Ann F. Mohrbacherview profile

Practicing Locations

USC Norris Comprehensive Cancer Center

Specializing In

Multiple Myeloma, Lymphoma, Bone Marrow Transplant, Leukemia

An D. Nguyenview profile
Book Online with Zocdoc

Practicing Locations

USC Norris Oncology/Hematology Huntington Beach
USC Norris Oncology/Hematology Irvine
USC Norris Oncology/Hematology Newport Beach
Minh D. Nguyenview profile

Practicing Locations

USC Norris Oncology/Hematology Irvine
USC Norris Treatment Center Newport Beach
Casey L. O'Connellview profile

Practicing Locations

USC Norris Comprehensive Cancer Center

Specializing In

Immune Blood Disorders, Bone Marrow Failure Syndromes, Anemia, Lymphoma, Leukemia, Clotting Disorders, Myeloproliferative Disorders

Caroline Piatekview profile

Practicing Locations

Keck Hospital of USC
LAC+USC Medical Center
USC Norris Comprehensive Cancer Center
Giridharan Ramsinghview profile

Practicing Locations

Keck Hospital of USC
USC Healthcare Center 2

Specializing In

Acute Leukemia, Allogeneic Bone Marrow Transplant

Anil Tulpuleview profile

Practicing Locations

USC Norris Comprehensive Cancer Center

Specializing In

Lymphomas, Hodgkin’s disease, HIV-related Lymphomas, HIV-related Kaposi’s Sarcoma

Louis A. Vandermolenview profile

Practicing Locations

USC Norris Oncology/Hematology Irvine
USC Norris Oncology/Hematology Newport Beach
Ilene C. Weitzview profile

Practicing Locations

USC Norris Comprehensive Cancer Center

Specializing In

Blood Clotting Disorders, Immune Blood Diseases, Hematologic Malignancies

George Yaghmourview profile