Myelogenous Leukemia

Chronic myelogenous leukemia (CML) also known as chronic myeloid leukemia or chronic granulocytic leukemia is a rare type of cancer of blood cells.

The term "chronic" in chronic myelogenous leukemia refers to the slow progression of cancer as compared to acute forms of leukemia and "myelogenous" (my-uh-LOHJ-uh-nus) refers to the type of cells that this cancer affects.

It might affect people of any age but older adults are at high risk of CML while it occurs rarely in children.

Common signs and symptoms of chronic myelogenous leukemia include:

• Easy bleeding
• Fatigue
• Fever
• Unintended Weight Loss
• Loss of appetite
• Tenderness on the rib
• Excessive Night Sweats

When to see a doctor

During the initial stage, CML may not be evident with its typical signs and symptoms. It can go unnoticed for months or years. Early detection yields better treatment outcomes. Set an appointment to see your doctor if you have any of the above signs that remain for a long time.

Chronic myelogenous leukemia is caused by the changes in the genes of the blood cells. The initiation of this process is not clear but its progression into chronic myelogenous leukemia has been explained.

• Human cells normally contain 23 pairs of chromosomes. In chronic myelogenous leukemia, a section of chromosome 9 switches places with a section of chromosome 22, creating an extra-short chromosome 22 and an extra-long chromosome 9. The extra-short chromosome 22 is called the Philadelphia chromosome (named for the city where it was discovered) which is present in the blood cells of 90 percent of people with chronic myelogenous leukemia.
• The Philadelphia chromosome creates a new gene. Genes from chromosome 9 combine with genes from chromosome 22 to create a new gene called BCR-ABL which contains instructions for the production of a protein called tyrosine kinase by the abnormal cells. Tyrosine kinase promotes cancer by allowing uncontrolled growth of certain blood cells.
• Blood cells originate in the bone marrow, a spongy material inside the bones. Normally the bone marrow produces the immature cells in a controlled manner which then mature and specialize into the various types of blood cells- red cells, white cells and platelets. In chronic myelogenous leukemia, the tyrosine kinase produced by the BCR-ABL gene causes too many white blood cells, most of which contain the abnormal Philadelphia chromosome. The diseased white blood cells build up rapidly, crowding out healthy blood cells and damaging the bone marrow.

Making a diagnosis of chronic myelogenous leukemia is done by performing several tests and procedures.

What you can do

• Make sure you follow any pre-appointment instructions. Ask your doctor if there's anything you need to do prior to the visit, such as restrict your diet.
• Make a list of symptoms you're experiencing.
• Make a list of the questions (starting with the most important one) that you would ask to your doctor.

If you are diagnosed with cancer, the following questions can be of value to you:

• What’s the type of cancer am I suffering and at which stage?
• Is my cancer curable? If yes, what are my treatment options? And if not, what should I expect?
• What are the potential side effects of each treatment?
• What will be the cost of treatment and what about insurance coverage?
• Can you provide any brochure or other printed material?
• What websites do you recommend?

Feel free to ask any additional question that’s in your mind at the time of visit.

What to expect from your doctor

Your doctor may ask:

• When was the first time you started experiencing the symptoms?
• Are there any factors that seem to worsen or improve your symptoms?
• Is there a family history of cancer?

Early diagnosis often yields better prognosis. Appropriate screening could help in better diagnosis and hence better treatment outcomes. Talk to your doctor about what type of cancer screening may be appropriate for you. In consultation with your doctor, you may review various guidelines to determine what works the best for you.

Diagnosis

Bone marrow biopsy Tests and procedures used to diagnose chronic myelogenous leukemia include:

• Physical examination

1. Checking vital signs such as pulse and blood pressure.
2. Palpating lymph nodes, spleen and abdomen for abnormalities.

• Blood tests: complete blood count (CBC)
• Blood chemistry tests to measure organ function
• Bone marrow tests: Bone marrow biopsy and bone marrow aspiration are used to collect bone marrow samples from hipbone for laboratory testing to detect Philadelphia chromosome.
• Analysis of blood or bone marrow samples to detect Philadelphia chromosome or the BCR-ABL gene can be done by tests such as fluorescence in situ hybridization (FISH) analysis and polymerase chain reaction (PCR) test.

Phases of chronic myelogenous leukemia

The phases of chronic myelogenous leukemia are indicative of disease progression. The phases are determined by measuring the proportion of diseased cells to healthy cells in the blood or bone marrow, with higher proportion of diseased cells correlating to more advanced stage.

Phases of chronic myelogenous leukemia are:

• Chronic phase: It is the earliest phase that responds best to treatment.
• Accelerated phase: It represents transitional phase when the disease is becoming more aggressive.
• Blastic phase: It is a severe, aggressive phase which is life-threatening.

The treatment for chronic myelogenous leukemia is aimed at eliminating the blood cells that contain the abnormal BCR-ABL gene. Though complete elimination of all diseased cells is not possible in majority of the patients, treatment can help long-term remission of the disease.

Targeted drugs

Targeted drugs attack specific molecule of cancer cells that are responsible for uncontrolled cell growth. In chronic myelogenous leukemia, the drugs are targeted at tyrosine kinase produced by the BCR-ABL gene.

Drugs that block the action of tyrosine kinase are:

• Imatinib (Gleevec)
• Dasatinib (Sprycel)
• Nilotinib (Tasigna)
• Bosutinib (Bosulif)
• Omacetaxine (Synribo)

Side effects of these targeted drugs include:

• swelling or puffiness of the skin
• nausea,
• muscle cramps
• rash
• fatigue,
• diarrhea, and skin rashes

A safe point at which people with chronic myelogenous leukemia can stop taking targeted drugs has not been determined. Hence, most people tend to continue taking targeted drugs even when blood tests reveal a remission of chronic myelogenous leukemia.

Blood stem cell transplant (Bone Marrow Transplant)

This is the only treatment that might provide definitive cure for CML. Owing to serious associated complications, it is reserved for people who are unresponsive to other treatments. It involves replacement of diseased cells with stem cells from donor.

Chemotherapy

Chemotherapy drugs are given in combination with other treatments for chronic myelogenous leukemia.

Biological therapy

Biological therapies utilize host immunity to fight cancer. For example Interferon can be used as an alternative treatment when the disease doesn’t respond to other treatments or when other drugs are contraindicated such as during pregnancy. Interferon can cause side effects like fatigue, fever, flu-like symptoms and weight loss.

Clinical trials

Clinical trials are the studies conducted to investigate potential drugs for treating a disease or a condition. Currently, thousands of clinical trials are being conducted to investigate new treatment options for cancer.

Till now, none of the alternative remedies have demonstrated an effective cure for chronic myelogenous leukemia.

However, some alternative medicinal options like Acupuncture Hypnosis, Massage, Meditation, Relaxation techniques and Yoga might be useful for coping with cancer symptoms and side effects of treatment.

Consult your doctor before applying any of these alternative remedies.

Lifestyle modifications are necessary in order to cope with chronic myelogenous leukemia.

Chronic myelogenous leukemia is a chronic disease which people will live with for years.

Cancer diagnosis can be a devastating and life changing news for patients and their families.

We bring you some ideas to help you cope:

• Ask your doctor about your cancer, including your treatment options and, if you like, your prognosis.
• Socialize and spend quality time with your friends and family as they provide you emotional as well as other support whenever needed.
• Join a support group or a counseling class.
• Access other related information from National Cancer Institute and the American Cancer Society.

Factors that increase the risk of chronic myelogenous leukemia include:

• Older age
• Male
• Radiation exposure, such as radiation therapy for certain types of cancer
• Family history is not a risk factor as the mutations are acquired later in life.

Chronic myelogenous leukemia (CML) can cause a variety of complications, including:

• Fatigue
• Anemia
• Excess bleeding due to decreased platelets count (thrombocytopenia). Easy bleeding and bruising, including frequent or severe nosebleeds, bleeding from the gums, or tiny red dots caused by bleeding into the skin (petechiae) are common.
• Pain: The excessive growth of the white blood cell results in expansion of the bone marrow causing bone pain or joint pain.
• Enlarged spleen: The spleen may become swollen or enlarged due to accumulation of excess cells in the spleen. Enlarged spleen results in abdominal fullness even after small meals or causes pain on the left side below the ribs.
• Infection: Diseased white blood cells cannot fight infection and CML treatment can cause neutropenia which have a combined role in increasing susceptibility to infection.
• Death

CML can be fatal of not treated properly.