Chronic Myelogenous Leukemia (CML) Treatment

Chronic myelogenous leukemia is a rare bone marrow cancer. Chronic myeloid leukemia affects older adults. It can be caused by a chromosome mutation that can occur spontaneously. Doctors aren't sure what causes the mutation.

Associated Anatomy:

Bone Marrow

Alternate Name:

Chronic granulocytic leukemia.

Chronic Myelogenous Leukemia (CML) Symptoms

There are rare chances of any signs of this disease. However, some of the signs and symptoms of chronic myelogenous leukemia are as follows:

• Frequent bleeding
• Loss of appetite.
• Fever
• Bone pain
• Always feeling tired
• Unexplained weight loss
• Night sweats
• Feeling of fullness or severe pain below the ribs on the left side.
• Short of breath

Chronic Myelogenous Leukemia (CML) Causes

The cause of chronic myelogenous leukemia is as follows:

• Chronic myelogenous leukemia is a condition caused due to genetic abnormality. The human body has 23 pairs of chromosomes, and any disruption in their number or structure can lead to severe diseases.
• In chronic myelogenous leukemia, the chromosomes 9 and 22 swap, which creates an extra little 22 chromosome with a long chromosome 9. The Philadelphia chromosome (short-22 chromosome) is present in 90% of patients’ blood cells.
• This combination results in forming a new gene, i.e., BCR-ABL.
• Due to these genes, the body produces an excess of tyrosine kinase protein that promotes the development of cancer cells.
• The cells of bone marrow now grow uncontrollably, resulting in chronic myelogenous leukemia.

Chronic Myelogenous Leukemia (CML) Stages

The three stages of chronic myelogenous leukemia are as follows:

• Chronic Phase: In the first phase or chronic phase, less than 10% of blood cells of bone marrow are the blast cells (immature blood cells).
• Accelerated Phase: In this phase, the blast cells become 10% to 19% of the total blood cells in the bone marrow.
• Blastic Phase: The blastic phase has more than 20% of blast cells of total blood cells.

Chronic Myelogenous Leukemia Typical Test

The common tests are blood tests or bone marrow biopsies. The cancer doctor will take your blood sample to detect any excess blood cells. The high number of white blood cells may indicate a positive result. For bone marrow testing or biopsy, the doctors may collect samples from your hipbone. Some tests like fluorescence in situ hybridization (FISH) analysis and the polymerase chain reaction (PCR) test helps in the detection of BCR-ABL genes.

Chronic Myelogenous Leukemia (CML) Treatment

These treatments are as follows:

• Targeted Therapies: In the targeted therapies, drugs such as tyrosine kinase inhibitors are given that attack the BCR-ABL genes. Some of these drugs are Imatinib (Gleevec), Dasatinib (Sprycel), Asciminib (Scemblix), and Ponatinib (Iclusig).
• Interferon Therapy: In interferon therapy, interferon, i.e., like an antibody naturally produced by the body, is introduced. Interferon-alpha is a popular and effective artificial interferon.
• Radiation Therapy: In radiation therapies, high-energy particles destroy cancer cells in a particular area.
• Chemotherapy: The chemotherapy involves killing extra-produced carcinogenic cells by using certain drugs, such as hydroxyurea.
• Surgery: Surgery is not a very successful process in this condition. It is helpful when cancer spreads to other organs, such as the spleen. Then, the removal of the spleen is done by surgical methods.
• Bone Marrow Transplants: The transplantation of healthy bone marrow into patients is an effective cure for this disease.

Risk Factors

The risk factors that increase the chances of chronic myelogenous leukemia are as follows:

• Older Age - It is uncommon among children of people of younger age.
• High radiation exposure - Radiation can cause genetic defects resulting in chronic myelogenous leukemia. However, it is not inherited.
• Males - There are more chances of chronic myelogenous leukemia in males than in females.

Possible Complications

The possible complications of chronic myelogenous leukemia (CML) are Hepatomegaly (enlarged liver), Splenomegaly (enlarged spleen), and severe anemia. Changes in blood cell counts may result in complications with normal bleeding or clotting processes. There is a severe shortage of WBCs, leading to recurrent infections.

Chronic Myelogenous Leukemia (CML) Preventions

Primary Prevention

Although, there is no specific prevention from diseases like chronic myelogenous leukemia. The prevention for it is as follows:

• Preventions like limiting exposure to radiation can be helpful in certain cases. If your work demands radiation exposure, you may take proper precautions to prevent gene damage.
• Acquire healthy lifestyle habits.

Secondary Prevention

• Try to add healthy food habits to your lifestyle.
• Exercise or do yoga daily for a better immune system.
• You may quit smoking to prevent the development of carcinogenic cells in your body.
• Limit alcohol intake.
• Avoid raw or uncooked foods, especially after the ages 60 to 65.

Epidemiology

• Approximately 15% of patients who have leukemia have chronic myelogenous leukemia.
• According to a survey conducted in the US, males are more likely to have this disease than females.
• Out of total statistical data collected, people over 65 years were more prone to this disease than people of younger age.

Chronic Myelogenous Leukemia (CML) Prognosis

Expected Prognosis

In the case of a successful bone marrow transplant, the patients may recover completely from the disease. In other cases, like targeted therapies, the patients may have to take medicines for several years to prevent severe harm. These drugs will slowly destroy carcinogenic cells, giving you a better lifestyle.

Natural Progression

The treatment of this disease early gives better chances of treating it properly. However, if not treated, the patients may get to the third stage, i.e., the blast stage. The abnormal blood cells will completely take over the normal blood cell production in this stage.

Pathophysiology

Chronic myelogenous leukemia (CML) leads to a shortage of normal blood cells. As a result, the human body doesn’t have enough RBCs to carry oxygen, resulting in shortness of breath. WBC fights pathogens and infections entering the body. The low count of WBC can lead to other infections.

The white blood cells that protect the body from infections tend to have abnormal growth, and these cells are incapable of performing their functions properly.

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