Chronic Myeloid Leukemia (CML)

What Is Chronic Myelogenous Leukemia?

Chronic myelogenous leukemia (CML) is a cancer of the blood in which too many granulocytes, a type of white blood cell, are produced in the bone marrow.

Normally, bone marrow cells mature into several different types of blood cells. CML affects the young blood cells (called blasts) that develop into a type of white blood cell (called granulocytes). The main function of granulocytes is to destroy bacteria. The blasts, which do not mature and become too numerous, remain in the bone marrow and blood.

Chronic Myeloid Leukemia

Chronic myelogenous leukemia can occur over a period of months or years. A specific chromosome rearrangement is found in patients with CML. Part of chromosome #9 breaks off and attaches itself to chromosome #22, so that there is an exchange of genetic material between these two chromosomes. This rearrangement changes the position and functions of certain genes, which results in uncontrolled cell growth. Other chromosome abnormalities can also be present.

CML occurs mainly in adults and is rare in children. According to the American Cancer Society, of the 48,610 leukemia cases expected in 2013. CML will account for 5,920 of the chronic cases in 2013.

Prevention of chronic myelogenous leukemia (CML)

There are no known ways to prevent CML.

Symptoms of Chronic Myelogenous Leukemia (CML)

Many people do not have symptoms in the early phase of CML. Instead, the leukemia is found during routine blood tests. When people do have symptoms from CML, the following are the most common. However, each individual may experience symptoms differently.

Symptoms may include:

  • Night sweats
  • Weight loss
  • Fever
  • Persistent weakness
  • Fatigue
  • Aches in bones and joints
  • Enlarged spleen

The symptoms of chronic myelogenous leukemia may resemble other blood disorders or medical problems. Always consult your doctor for a diagnosis.

Blood tests

Bone marrow aspiration

Bone Marrow Aspiration and Biopsy

Bone marrow aspiration and biopsy involves the removal of bone marrow, blood, and a small piece of bone by inserting a needle into the hipbone or breastbone. This type of biopsy is performed either from the sternum (breastbone) or the iliac crest hipbone (the bone area on either side of the pelvis on the lower back area). The skin is cleansed and a local anesthetic is given to numb the area. A long, rigid needle is inserted into the marrow, and cells are aspirated for study; this step is occasionally uncomfortable. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer. A core biopsy (removing a small bone ‘chip’ from the marrow) may follow the aspiration.

Cytogenetic analysis

Cytogenetic Analysis

In this laboratory test, cells in a sample of blood or bone marrow are viewed under a microscope to look for certain changes in the structure or number of chromosomes in the lymphocytes.

Physical exam and history

Physical Exam and History

Physical exam and history is an exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Please provide your medical records to us before your appointment. At the visit itself, the nurses and doctors will ask additional questions and carry out a detailed physical exam.

Chronic Myelogenous Leukemia (CML) Staging

Most types of cancer are staged to communicate the size of the tumor and how far the cancer has spread. But leukemia rarely causes tumors. Also, because it is in your bone marrow and blood, it has already spread all over your body. Instead of stages, doctors describe CML in terms of phases: chronic phase, accelerated phase, and blast phase.

Chronic Phase

During this phase, you have fewer than 10% blasts, which are immature white blood cells, in your blood or bone marrow. You usually have relatively mild symptoms (if any) and respond to standard treatments.

Accelerated Phase

During this phase, you have more than 10% but fewer than 20% blasts, which are the immature white blood cells. You may have a fever, poor appetite, and weight loss. During this phase, your symptoms and blood counts may not respond as well to treatment. Your leukemia cells may have developed other chromosomal changes, in addition to the Philadelphia chromosome (a chromosomal abnormality associated with CML).

Blast Phase

During this phase, you have more than 20% of the immature blasts in your blood or bone marrow. These blast cells often spread to other areas of your body outside the bone marrow. When tiredness, fever, and an enlarged spleen occur during the blastic phase, it is called blast crisis. This phase is considered aggressive.

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