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What is chronic myeloid leukemia?

Chronic myelogenous leukemia (CML) is a type of cancer that causes the body to produce large numbers of white blood cells (myelocytes). These myelocytes, called leukemia cells, cannot fight infection very well.

When leukemia cells build up in the blood and bone marrow, there is less room for healthy blood cells. This can cause infections, anemia and easy bleeding.

CML usually gets worse slowly. It is sometimes referred to as chronic myeloid leukemia or chronic granulocytic leukemia.

CML is more common in men than in women. It occurs more frequently in adults in their 50s and is rarely seen in children. Most people with CML have a gene change (mutation) called the Philadelphia chromosome.

Symptoms of CML include weakness and fatigue, fever, night sweats, poor appetite and weight loss. The spleen may become swollen and painful.

CML is classified into three distinct phases: chronic phase, accelerated phase and the blast crisis phase.

Our approach

CML requires accurate diagnosis and expert treatment. At Northwell Health Cancer Institute, we provide the most advanced therapies for CML, along with personalized treatment plans. Your integrated, multidisciplinary team of physicians meets regularly to discuss your treatment, share ideas and best practices, and ensure your treatment milestones are reached. 

If you are diagnosed in the beginning stages of CML (chronic phase), a tyrosine kinase inhibitor may be prescribed. If you do not have a relapse, you may not need additional treatment. However, if you relapse, you may require a stem cell transplant.

If you are diagnosed with CML in the later stages (accelerated or blast crisis phase), treatment may involve having chemotherapy or a tyrosine kinase inhibitor before having a stem cell transplant. This can increase the chances of a successful transplant. Because convenience is a primary focus throughout your treatment, every effort is made to provide treatment in one location.

It’s important to note that dramatic changes in life expectancy in patients with CML have occurred since 2002. Today, over 90 percent of patients have long-term remissions. Your physician will work closely with highly skilled hematologists to ensure you have the best possible outcome.

Research at Northwell

Through collaboration with leading research laboratories, you may have the opportunity to participate in clinical trials as part of your treatment for CML. While not every patient is a candidate for clinical trials, your care team will work with you to determine eligibility. Learn more about clinical trials at Northwell Health.

Symptoms

The early signs of CML and other chronic leukemias of lymphocytes may be like the flu or other common diseases, including:

  • Fatigue or weakness
  • Shortness of breath
  • Fever
  • Weight loss
  • Abdominal swelling or discomfort due to an enlarged spleen
  • A feeling of fullness
  • Itching
  • Bone pain
  • Bleeding

Symptoms of CML may be due to other conditions. This is why it’s important to get an evaluation from your doctor. The Northwell Cancer Institute offers state-of-the-art testing for CML. If diagnosed with the disease, your treatment regimen needs will be based on findings from tests used during diagnosis.

Causes

The cause of CML is unknown. However, research has found that the disease develops from genetic changes in the myeloid cells. Northwell Health Cancer Institute currently is conducting extensive research to uncover the cause of CML. This is leading to more clinical capabilities to treat the disease.

Risk factors

Known risk factors for CML include:

  • Age—CML is most common in adults older than 60.
  • Gender—CML is more common in men.
  • Radiation exposure—Individuals who were survivors of the 1945 atomic bombings in Japan are more likely to develop CML. Radiation therapy for a condition called ankylosing spondylitis has also been linked to CML.

Diagnosis

The first step to making a chronic myeloid leukemia diagnosis is usually a physical exam. The doctor will also consider personal and family medical history. If chronic lymphocytic leukemia is suspected, you will be sent for additional tests—usually administered on an outpatient basis—which include:

  • Complete blood count (CBC) with differential—Blood is drawn to measure the number of red blood cells, white blood cells and platelets in the blood. The amount of hemoglobin (substance in the blood that carries oxygen) and the hematocrit (the amount of whole blood that is made up of red blood cells) are also measured. The differential will count the different types of white blood cells that may be present.
  • Peripheral blood smear—A blood sample is checked for the number and kinds of white blood cells, the number of platelets and changes in the shape of blood cells.
  • Bone marrow aspiration and biopsy—A small sample of bone marrow and bone is removed. The sample is examined by a pathologist for signs of leukemia.
  • Immunophenotyping—A process used to identify cells, based on the types of antigens or proteins on the surface of the cell. This process is used to diagnose specific types of leukemia and lymphoma by comparing cancer cells to their normal counterparts. Flow cytometry and immunohistochemistry are the two tests used to provide optimal immunophenotyping.
  • Blood chemistry studies—A blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
  • Cytogenetic analysis—The chromosomes in the cells of a blood or bone marrow sample are examined. Abnormalities in the chromosomes could be a sign of leukemia. Cytogenetics and a related procedure called fluorescence in-situ hybridization (FISH) are used to identify whether or not abnormal chromosomes are present. 
  • Molecular genetics—The molecular genetics laboratory looks for expressions of disease that may have escaped detection by other methods.

Imaging tests

  • Chest X-rays—X-rays help doctors look for tumors in the chest and lungs or evidence of infection.
  • CT or CAT scan (computerized axial tomography)—More detailed than an X-ray, this procedure uses a combination of X-rays and computer technology to produce detailed images if needed.
  • MRI (magnetic resonance imaging)—A powerful magnet, radio waves and computer imaging combine to create highly detailed pictures of areas inside the body, if needed.
  • PET scan (positron emission tomography)—Small amounts of radioactive sugar are injected to highlight cancers and areas of infection and inflammation.

Treatment types

For some patients with CML, immediate treatment is not necessary. Instead, the disease is monitored carefully without active treatment. This is also called active surveillance or watchful waiting. Other patients require immediate treatment. Treatment is recommended for patients with symptoms or worsening blood counts. Treatments include:

Targeted therapy—Targeted therapy may be prescribed by your medical oncologist. In the case of CML, the target is a protein called the BCR-ABL tyrosine kinase enzyme. There are several drugs used to target these enzymes for the purpose of treating CML. Research has shown targeted therapy for CML to be as effective as chemotherapy.

Chemotherapy—Chemotherapy may be used to treat chronic or accelerated phase CML if it is not respoind to targeted therapies.

Stem cell/bone marrow transplantation—Although a transplant is the only treatment that can cure CML, it is not frequently used because targeted therapies are highly effective with fewer side effects. When it is necessary, chemotherapy and/or radiation therapy is used to destroy cancer cells in bone marrow, blood and other parts of the body, before being replaced with blood stem cells that can create healthy bone marrow.

Immunotherapy—this treatment is designed to boost the body’s natural defenses to fight CML. Interfero or other immunotherapy medications can reduce the number of white blood cells as a treatment for chronic phase CML.

Living with

  • Take your medicines exactly as prescribed. You may get medicine for nausea, vomiting, or pain (although leukemia rarely causes pain). Call your doctor if you think you are having a problem with your medicine. You will get more details on the specific medicines your doctor prescribes.
  • Eat healthy food. If you do not feel like eating, try to eat food that has protein and extra calories to keep up your strength and prevent weight loss. Drink liquid meal replacements for extra calories and protein. Try to eat your main meal early.
  • Get some physical activity every day, but do not get too tired. Keep doing the hobbies you enjoy as your energy allows.
  • Take steps to control your stress and workload. Learn relaxation techniques.
    • Share your feelings. Stress and tension affect our emotions. By expressing your feelings to others, you may be able to understand and cope with them.
    • Consider joining a support group. Talking about a problem with your spouse, a good friend, or other people with similar problems is a good way to reduce tension and stress.
    • Express yourself through art. Try writing, dance, art, or crafts to relieve tension. Some dance, writing, or art groups may be available just for people who have cancer.
    • Be kind to your body and mind. Getting enough sleep, eating a nutritious diet, and taking time to do things you enjoy can contribute to an overall feeling of balance in your life and help reduce stress.
    • Get help if you need it. Discuss your concerns with your doctor or counselor.
  • If you are vomiting or have diarrhea:
    • Drink plenty of fluids (enough so that your urine is light yellow or clear like water) to prevent dehydration. Choose water and other caffeine-free clear liquids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
    • When you are able to eat, try clear soups, mild foods, and liquids until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O.
  • Avoid colds and flu. Get a pneumococcal vaccine shot. If you have had one before, ask your doctor whether you need another dose. Get a flu shot every year. If you must be around people with colds or flu, wash your hands often.
  • Do not smoke. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
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