CML- Chronic Myeloid Leukemia

Overview of CML- Chronic Myeloid Leukemia

Chronic myeloid leukaemia is a type of cancer in which there is excessive growth of white blood cells without any differentiation. Consequently, there is overproduction of immature blast cells.

Chronic myeloid leukaemia (Daimi sartaan khoon/دائمی سرطان  خون ) is a myeloproliferative disorder. It is white blood cells cancer in which increased proliferation of the granulocytic cell line. So, there is an increased number of granulocytes, blast cells and immature precursors on the peripheral blood cell profile. It accounts for 20% of all leukaemia affecting adults. It's a type of cancer that starts in certain blood-forming cells of the bone marrow.

  • CML Prevalence

Globally, about 15% of all new cases of leukaemia are chronic myeloid leukaemia. About 1 person in 526 will get CML in their lifetime. The average age at diagnosis of CML is around 64 years. Almost half of the cases are diagnosed in people 65 and older.

Signs and Symptoms of CML- Chronic Myeloid Leukemia

Some common signs and symptoms of CML are as follows:

  • Low level of RBCs( Anemia) leads to shortness of breath, fatigue, and weakness
  • Leukopenia is a shortage of normal white blood cells that leads to a high risk of infections
  • Neutropenia means that the level of normal neutrophils is low leading to bacterial infections
  • Thrombocytopenia is a shortage of blood platelets which causes frequent bleeding and bruises

Other signs and symptoms may include:

  • Bone Pain
  • Enlarged spleen
  • Feeling to be filled after eating small
  • Fever
  • Weight loss
  • Lack of appetite
  • High level of sweating at night
  • Pain under ribs

Types of CML- Chronic Myeloid Leukemia

The growth or spread of CML is called the phase or stages. There are the following stages of CML to estimate its growth.

  • Chronic Stage

The blood and bone marrow contain >10% immature white blood cells (blast cells). This phase can last for several years. However, without effective treatment, the disease can progress to the accelerated or blast phases. About 90% of people have chronic phase CML when they are diagnosed. Abdomen might be swollen due to an enlarged spleen. Some people with chronic phase CML have symptoms when they are diagnosed and some do not. Most symptoms are treatable.

  • Accelerated Stage

In this phase of CML patients have 10% - 19% blasts in both the blood and bone marrow or > 20% basophils in the peripheral blood.  These cells sometimes have new cytogenetic changes in addition to the Philadelphia chromosome, because of additional DNA damage and mutations in the CML cells.

  • Blast Stage

In the blast phase, there are 20% or more blasts in the blood or bone marrow, and it is difficult to control the number of white blood cells. The CML cells often have additional genetic changes as well. The blast cells can look like the immature cells seen in patients with other types of leukaemia, specifically acute lymphoblastic leukaemia.  . Patients in the blast phase have a fever, an enlarged spleen and weight loss.

  • Resistant CML

Resistant CML is CML that occurs when it does not respond to treatment. If the CML does recur, there will be another round of tests to learn about the extent of the disease.

Causes of CML- Chronic Myeloid Leukemia

The exact cause of CML is not known, but several risk factors have been identified. The following are some of the known causes and risk factors for CML:

  • Genetic mutations: Most cases of CML are caused by a genetic mutation in the bone marrow cells called the Philadelphia chromosome. This mutation causes the bone marrow cells to produce an abnormal protein called BCR-ABL, which leads to the production of too many white blood cells.
  • Radiation exposure: Exposure to high levels of ionizing radiation, such as from nuclear accidents or medical treatments, has been linked to an increased risk of developing CML.
  • Age: CML is more common in older adults, with the average age of diagnosis being 60 years.
  • Gender: CML is slightly more common in males than in females.
  • Family history: A small percentage of CML cases are inherited, so having a family member with CML can increase your risk.
  • Environmental factors: Exposure to certain chemicals, such as benzene and formaldehyde, has been linked to an increased risk of developing CML.

It is important to note that having one or more of these risk factors does not necessarily mean that a person will develop CML. Many people with CML have no known risk factors.

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Risk Factors of CML- Chronic Myeloid Leukemia

Factors that increase the risk of chronic myelogenous leukemia:

  • Radiation exposure:  Mostly those who are being exposed to high-dose radiation may be at risk of getting CML.
  • Age:  It is higher in older patients.
  • Gender: It mostly occurs in males rather than in females.

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Prevention

The only potentially avoidable risk factor for CML is exposure to high doses of radiation and there is no other prevention that can prevent CML.

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Diagnosis

 

  • Bone marrow Biopsy
  • Complete blood count tests reveal the blood cells with a lot of early (immature) cells called myeloblasts or blasts
  • Bone marrow test in which the bone marrow is often hypercellular because it's full of leukemia cells
  • Blood chemistry tests show high and low levels of mineral
  • Genetic tests are used to look for BCR-ABL gene
  • Conventional cytogenetic
  • Fluorescent in situ hybridization (FISH) is also used to check the presence of pieces of the BCR-ABL gene on chromosome
  • Polymerase chain reaction (PCR) is used to check the number of genes. It can detect even a minute amount of BCR-BCL in leukemia cells.  During treatment, it is used to detect copies of BCR-ABL even when cells are not seen under a microscope
  • Computed tomography CT scan is used to check the growth of leukemia in an organ
  • Magnetic resonance imaging (MRI) is helpful to check growing of leukemia in the brain and spinal cord
  • Ultrasound is used to check lymph nodes near the Kidney spleen and liver

Treatment of CML- Chronic Myeloid Leukemia | When to Consult a Doctor

The following are the main therapies used for the treatment of CML.

1. Home Remedies

You may find relief through alternative therapies, such as:

  • Exercise
  • Journal writing
  • Massage
  • Relaxation techniques
  • Yoga
  • Connect with cancer survivors

2. Drug Therapy 

Some drugs are targeted for their treatment. Their main target is to stop the action of tyrosine kinase that is produced by the BCR-ABL gene.

  • Imatinib (Gleevec)
  • Dasatinib (Sprycel)
  • Nilotinib (Tasigna)
  • Bosutinib (Bosulif)
  • Ponatinib (Iclusig)
  • Bone Marrow Transplantation

High doses of chemotherapy drugs are used to kill the blood-forming cells in the bone marrow of patients. The blood stem cells from a donor are infused into your bloodstream. The new cells form new, healthy blood cells to replace the diseased cells.  There are two types of bone marrow transplantation: allogeneic (ALLO) and autologous (AUTO). ALLO uses donated stem cells, while AUTO uses the patient's stem cells. 

3. Chemotherapy

 It kills fast-growing cells in the body, including leukemia cells.  Sometimes Chemotherapy drugs are combined with targeted drug therapy to treat aggressive chronic myelogenous leukemia.

4. Immunotherapy

Interferon (Alferon, Infergen, Intron A, Roferon-A) is a type of immunotherapy. It can reduce the number of white blood cells and sometimes decrease the number of cells that have the Philadelphia chromosome, Interferon was the primary treatment for chronic phase CML before imatinib became available.

 

After the completion of treatment, ongoing follow-ups are needed for careful monitoring of patients.