Chronic Myeloid Lukemia

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Chronic Myeloid Lukemia (CML) 

Chronic myelogenous leukemia (CML) is a type of cancer that starts in the blood-forming cells of the bone marrow and invades the blood. In CML, leukemia cells tend to build up in the body over time, but in many cases people don't have any symptoms for at least a few years. The term "chronic" in chronic myelogenous leukemia indicates that this cancer tends to progress more slowly than acute forms of leukemia. In time, the cells can also invade other parts of the body. CML can also change into a fast-growing acute leukemia that invades almost any organ in the body.

Causes


  • Radiation treatments used in the past to treat thyroid cancer or Hodgkin’s lymphoma
  • Nuclear disaster


Symptoms


  • Easy bleeding
  • Feeling run-down or tired
  • Fever 
  • Frequent infections
  • Losing weight without trying
  • Loss of appetite
  • Pain or fullness below the ribs on the left side
  • Pale skin
  • Sweating excessively during sleep (night sweats)

Exams & Tests 

  • Bone marrow biopsy
  • Blood and bone marrow testing for the presence of the Philadelphia chromosome
  • Platelet count 
  • Risk factors
  • Older age
  • Being male
  • Radiation exposure, such as radiation therapy for certain types of cancer

Phases

Chronic: - 

The chronic phase is the earliest phase and generally has the best response to treatment. During this the patients may not have any symptoms or may only present with mild symptoms like fatigue, joint pain or abdominal fullness. In the absence of treatment, the disease progresses to an accelerated phase.

Accelerated: - 

The accelerated phase is a transitional phase when the disease becomes more aggressive. It is usually defined by the following:
10–19% myeloblasts in the blood or bone marrow >20% basophils in the blood or bone marrow
Platelet count <100,000, unrelated to therapy
Platelet count >1,000,000, unresponsive to therapy
Cytogenetic evolution with new abnormalities
Increasing splenomegaly or white blood cell count, unresponsive to therapy

The accelerated phase signals that the disease is progressing and transformation to blast crisis is imminent. Drug treatment often becomes less effective in the advanced stages.

Blastic: - 

Blastic phase is a severe, aggressive phase that becomes life-threatening. It is the final phase in the evolution of CML, and behaves like an acute leukemia, with rapid progression and short survival. Blast crisis is diagnosed if any of the following are present in a patient with CML:
>20% myeloblasts or lymphoblasts in the blood or bone marrow
Large clusters of blasts in the bone marrow on biopsy
Development of a chloroma (solid focus of leukemia outside the bone marrow)

Treatments

Blood stem cell transplant

A blood stem cell transplant, also called a bone marrow transplant, offers the only chance for a definitive cure for chronic myelogenous leukemia. However, it's usually reserved for people who haven't been helped by other treatments because blood stem cell transplants have risks and carry a high rate of serious complications.

During a blood stem cell transplant, high doses of chemotherapy drugs are used to kill the blood-forming cells in your bone marrow. Then blood stem cells from a donor or your own cells that were previously collected and stored are infused into your bloodstream. The new cells form new, healthy blood cells to replace the diseased cells.

Chemotherapy

Chemotherapy drugs are typically combined with other treatments for chronic myelogenous leukemia. Often, chemotherapy treatment for chronic myelogenous leukemia is given as a tablet you take by mouth. Side effects of chemotherapy drugs depend on what drugs you take.

Biological therapy

Biological therapies harness your body's immune system to help fight cancer. The biological drug interferon is a synthetic version of an immune system cell. Interferon may help reduce the growth of leukemia cells. Interferon may be an option if other treatments don't work or if you can't take other drugs, such as during pregnancy. Side effects of interferon include fatigue, fever, flu-like symptoms and weight loss.
1. Dr. Dharma Chaudhary, Sr. Consultant & Director, Centre for Bone Marrow Transplant, BLK Super Speciality Hospital, Pusa Road, New Delhi - 110005, India.
He is an expert in Bone Marrow Transplant and having a rich experience in this field.


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