Opinion: Blood cancers are the fifth most common type of cancer. Now I ask, ‘Why me?’

Halpern was an assistant U.S. attorney for more than 30 years. He retired in 2020. He is a member of The San Diego Union-Tribune’s Community Voices Project. Last year, he moved from Mission Hills to Boston for treatment at the Dana-Farber Cancer Institute.

Occasionally, life throws you a curve. I certainly felt that way when I was diagnosed with a generally incurable and rare cancer of the blood and bone marrow.

As luck would have it, I had retired only weeks earlier from my position as an assistant U.S. attorney in San Diego. I had been working as a federal prosecutor since moving to San Diego in October 1984. Over the course of my career, I was fortunate to prosecute dozens of high-profile cases: including cases against U.S. congressmen, the executive director of the CIA, bribery cases against California state judges, the first prosecution of a foreign national for making illegal contributions in a San Diego mayoral contest, the largest individual criminal tax prosecution in the history of the IRS, the first federal case involving a violation of the presidential embargo of Libya, the first federal cases involving the distribution of anabolic steroids and human growth hormone, a landmark tax fraud case brought against former San Diego Mayor Maureen O’Connor for misusing her husband’s charitable foundation, and many, many others.

My wife Marcia had also recently retired. Prior to my illness, she taught science at Muirlands Middle School. All three of our children (Griffin, Moose and Gator) attended public school in San Diego and went to college in California. For the past 30 years, we lived in Mission Hills.

All in all, life was pretty darn good. Indeed, my entire family appeared to be in remarkably good health. In my 60s, I was still working out seven days a week (or, as I preferred to put it to my friends, I only worked out on days ending with a “y”) and regularly cycling more than 200 miles per week. However, unbeknownst to me, my platelet count was slowly rising. Although this rise was reflected in my annual blood tests, my doctor initially did not even think it worthy of mention.

For the non-medical folks out there, I should note that platelets (also known as thrombocytes) are small, colorless cell fragments in our blood that form clots and stop or prevent bleeding. Platelets are typically produced in bone marrow, the sponge-like tissue in the center of bones. Bone marrow also produces red blood cells (erythrocytes — doctors sure do love their Latin and Greek terminology) and a half-dozen distinct types of white blood cells (monocytes, lymphocytes, neutrophils, eosinophils, basophils and macrophages).

A normal platelet count is anywhere between 140,000 and 370,000 platelets (per microliter of blood). In 2013, my platelet count was a nice, normal 280,000; but over the next seven years, it rose steadily. By October 2020, it had risen to 712,000 (a condition referred to in the medical community as thrombocytosis, i.e., too many platelets, aka thrombocytes). My routine blood tests also showed that my red and white blood cell counts were now slightly off.

More ominously, additional testing revealed the presence of a JAK2 mutation in my blood cells. This mutation is acquired (not inherited) and is present in most patients with myeloproliferative neoplasms — a group of diseases in which the bone marrow makes too many red blood cells, white blood cells or platelets. At this point, my internist referred me to a hematologist (a doctor who specializes in blood cancers and blood-related disorders).

Blood cancers are the fifth most common type of cancer in the world. Around 1.3 million new cases of blood cancer worldwide were diagnosed in 2020. While these cases fall generally within a family of five diseases (leukemia, lymphoma, myelodysplastic syndromes or MDS, myeloproliferative disorders or MPD, and multiple myeloma), there are more than 100 different subtypes, some of which are exceedingly rare and difficult to diagnose. Each of these cancers possesses its own challenges, treatments, and varying outcomes.

Blood cancers develop when stem cells residing in the bone marrow gather DNA mutations that result in the production of too many, too few, or faulty blood cells. Some DNA changes might be caused by exposure to risk factors in our environment (such as chemicals or radiation) and others may be genetic. DNA mutations also occur naturally over time as individuals age, and our cells become less efficient at picking up and correcting these changes. This is one reason why older people, in general, have a higher risk of developing cancer.

Exactly what type of blood cancer did I have? How should it be treated? Was it fatal? How long was I likely to live? Unfortunately, the answers to these questions are not straightforward and this is where my story starts getting interesting. In the hope that it might help others, I’ve decided to document this journey. From time to time I will publish my chapters here.