Chronic Myeloid Leukemia (CML)

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After completing a thorough lab analysis of your recent biopsy, a specialized doctor called a pathologist reported a diagnosis of chronic myeloid leukemia (CML), which is a type of blood cancer that accounts for about 15% of leukemia cases. The average age at diagnosis is 65 and the disease most often affects adults.

About the Condition

Leuk Diag 12-21-09The soft inner tissue that fills the cavities of bones is called bone marrow. In adults, certain bones such as the skull, shoulder blades, ribs, pelvis and vertebrae (backbones) contain red bone marrow, which is the site of the body’s blood stem cells. These cells develop into blood-forming cells that then produce various components of the blood such as red and white blood cells and platelets. (Blood stem cells are not the same as embryonic stem cells.)

Myeloid cells in the bone marrow are blood-forming cells that become mature red blood cells, platelets and certain types of white blood cells. Chronic myeloid leukemia is cancer that occurs when myeloid cells in the bone marrow do not proliferate, mature and expire in a normal manner. The extra cells that result can spread beyond the bone marrow to organs such as the spleen or liver, which may become enlarged. The term chronic refers to the fact that the disease is comprised of cells that appear mature, even though they are not truly normal.

Many patients with CML have no adverse effects; some may experience symptoms that include fatigue, fever, night sweats, shortness of breath, increased risk of infection, weight loss, excessive bruising or bleeding, bone pain and upper left abdominal discomfort.

There are three phases of the disease, based mainly on the percentage of myeloblasts (blasts), in the blood and bone marrow. These immature white blood cells gradually accumulate and block the production of healthy blood cells. About 85% of cases are Chronic CML, marked by less than 10% blasts and mild or no symptoms. Between 10–20% blasts are present along with other blood count factors and moderate symptoms in Accelerated CML. Blast Crisis CML is the most severe phase, with more than 20% blasts and more pronounced symptoms. Your doctor can tell you more about your CML phase.

Treatment Options

Deciding on a treatment plan for CML can be complex and depends upon a variety of factors, such as the phase of the disease and your age, level of spleen enlargement and personal preferences. The following treatment possibilities are available:

Chemotherapy – The use of anti-cancer drugs, or chemotherapy, provides a way to kill leukemia cells systemically (throughout the body) via the bloodstream. Often a combination of several drugs is given, which varies based on the stage of cancer.

Targeted Therapy – This newer form of anti-cancer therapy targets specific abnormalities within just the cancer cells to slow or stop their growth using drugs such as imatinib, dasatinib and nilotinib. It is used for certain CML patients who may benefit from this type of treatment.

Biologic Therapy – In certain cases, therapy that employs man-made biologics (i.e., synthetic proteins) such as interferon is used to treat CML.

Radiation Therapy – Radiation therapy is not a main treatment for CML, but does provide a way to reduce bone pain and discomfort caused by enlarged lymph nodes or organs. External beam radiation is generally used, in which a high energy X-ray machine directs radiation at the affected area(s).

(Hematopoietic) Stem Cell Transplant – Stem cell transplant involves the transfer of specific blood-forming (hematopoietic) cells after high-dose chemotherapy (and at times added radiation therapy). Cancer cells in the body along with healthy blood-forming cells in the bone marrow are destroyed by chemotherapy. Stem cells harvested from the bone marrow or blood of a matched donor are frozen and later thawed when needed for infusion into the body to help the bone marrow regenerate. When the stem cells come from a matched donor it is called an allogeneic transplant. Allogeneic stem cell transplant is the only treatment that may cure some CML patients, but not all patients are candidates for the procedure.

Donor Lymphocyte Infusion – After stem cell transplant, certain CML patients may also receive an infusion of lymphocytes from their stem cell donor. The transferred lymphocytes — a type of white blood cell made in the bone marrow that fights infection — can trigger an immune reaction in the patient against any remaining cancer cells.

Leukapheresis – Some CML patients may have excess white blood cells removed from their blood via leukapheresis, which is a process similar to dialysis.

Surgery – In rare cases when an enlarged spleen from CML presses on other organs and causes pain, a splenectomy may be performed to remove it, which does not cure the leukemia but can improve blood cell counts.

You may also consider participating in clinical trials. These investigative studies help doctors learn about new treatments and better ways to use established treatments. Talk with your doctor about the possibility of taking part in a clinical trial in your area.

What You Can Do

You can choose to take an active role in your health and well-being. Learn as much as you can about your condition and have a list of questions ready each time you meet with your doctor. Join a cancer support group, and talk with your family, friends, clergyperson or counselor as you feel comfortable. Keep all of your doctor’s appointments and promptly report any new symptoms or treatment side effects that develop. Also be sure to eat healthy foods and stay as active as you can.

Additional Resources

American Cancer Society, 800.227.2345, www.cancer.org
The Leukemia & Lymphoma Society, 800.955.4572, www.leukemia-lymphoma.org

This patient resource sheet is provided to you as a service of CBLPath® and is intended for information purposes only. It may not fully describe all aspects of your diagnosis and is not meant to serve as medical advice or a substitute for professional medical care. Your physician can provide you with a thorough explanation of your diagnosis and appropriate treatment options, which may vary. Only you and your physician can determine your best treatment plan.

Updated 8.12