Overview
Chronic myelogenous leukemia (CML) is an uncommon type of cancer that affects the bone marrow, the spongy tissue inside bones where blood cells are made. It causes an increased number of white blood cells in the blood. CML progresses more slowly than severe forms of leukemia, and it typically affects older adults, though it can occur at any age. The disease is caused by a gene change that allows too many white blood cells to grow, most of which contain the Philadelphia chromosome. Symptoms may include bone pain, bleeding easily, fatigue, fever, weight loss, loss of appetite, and bone pain below the ribs on the left side. If you have any persistent symptoms that worry you, it's important to see a healthcare provider.
Understanding the disease
Symptoms
Symptoms of chronic myelogenous leukemia may include bone pain, bleeding easily, feeling full after eating a small amount of food, fatigue, fever, weight loss without trying, loss of appetite, pain or fullness below the ribs on the left side, excessive sweating during sleep, and blurry vision caused by bleeding in the back of the eye. If you have any persistent symptoms that worry you, it's important to make an appointment with your health care provider.
Risk Factors
Risk factors for developing chronic myelogenous leukemia (CML) include older age, being male, and exposure to radiation therapy for certain types of cancer. CML is more common in older people and men than in children and teens. Radiation therapy for certain types of cancer has been linked to an increased risk of CML. Family history is not considered a risk factor for developing CML, as the gene change that leads to the disease is believed to occur after birth.
Development
Chronic myelogenous leukemia (CML) develops due to changes in the bone marrow cells, which cause an increased number of white blood cells. The process leading to CML is not entirely clear, but doctors have identified the Philadelphia chromosome, a genetic abnormality, as a key factor. The Philadelphia chromosome is formed by a translocation between chromosomes 9 and 22, resulting in the fusion of two genes: ABL and BCR. This fusion gene produces the BCR-ABL protein, which is a tyrosine kinase and promotes the growth and survival of immature white blood cells. As a result, too many diseased white blood cells are produced, crowding out healthy blood cells and damaging the bone marrow. CML typically occurs in older adults and rarely in children, though it can happen at any age.
Assessment and Diagnosis
Triage
You should see a doctor if you have persistent symptoms that worry you, even if you have not been diagnosed with chronic myelogenous leukemia (CML). The symptoms include bone pain, bleeding easily, feeling full after eating a small amount of food, fatigue, fever, weight loss without trying, loss of appetite, pain or fullness below the ribs on the left side, excessive sweating during sleep, and blurry vision caused by bleeding in the back of the eye. It is essential to consult your healthcare provider for further evaluation and appropriate treatment.
Diagnosis
Diagnosis of chronic myelogenous leukemia involves a combination of physical exams, blood tests, and laboratory procedures. To diagnose the condition, healthcare providers typically perform the following steps:
- Physical exam: A healthcare provider conducts a thorough physical exam, checking vital signs, lymph nodes, spleen, and abdomen for any swelling.
- Blood tests: A sample of blood is taken and sent to a laboratory for a complete blood count (CBC). A CBC helps determine the number of different types of blood cells, including white blood cells, which are often elevated in cases of chronic myelogenous leukemia. Blood tests may also measure organ function to ensure they are working properly. These tests and procedures help healthcare providers determine the presence and stage of chronic myelogenous leukemia.
Management and Treatment
Complications
Potential complications of chronic myelogenous leukemia (CML) can include:
- Infections: Due to a reduced number of healthy white blood cells, people with CML are at a higher risk of developing infections.
- Anemia: As the bone marrow is damaged and produces fewer red blood cells, anemia can occur. This can result in fatigue, weakness, and shortness of breath.
- Bleeding: The reduced number of platelets in the blood can lead to increased risk of bleeding and bruising.
- Fatigue: Fatigue is a common symptom of CML and can be caused by anemia, infections, or the disease itself.
- Bone pain: Advanced stages of CML may cause bone pain, especially in the back, ribs, and pelvis.
- Spleen enlargement: The spleen may become enlarged due to the presence of a large number of diseased white blood cells. This can lead to discomfort and potentially serious complications.
- Cardiovascular complications: In some cases, CML can cause blood vessels to narrow or become blocked, increasing the risk of heart attack or stroke.
- Financial and emotional burden: The ongoing treatment and management of CML can result in financial strain and emotional stress for patients and their families. It is essential to work closely with healthcare providers to manage and monitor these potential complications throughout the course of treatment.
Home Remedies
It is essential to consult with a healthcare professional for personalized advice and treatment recommendations for chronic myelogenous leukemia. Always follow the guidance of your doctor and continue with any prescribed treatments or medications.
Treatment
The treatments for chronic myelogenous leukemia (CML) include:
- Targeted therapy: Tyrosine kinase inhibitors (TKIs) are the primary treatment for CML. These drugs target the abnormal BCR-ABL gene and prevent the production of diseased blood cells. Examples of TKIs include imatinib (Gleevec), nilotinib (Tasigna), and dasatinib (Sprycel).
- Chemotherapy: Chemotherapy may be used in combination with targeted therapy, especially in advanced stages of CML. Drugs like hydroxyurea, busulfan, or cytarabine may be administered to reduce the number of diseased blood cells.
- Stem cell transplant: A stem cell transplant, also known as a bone marrow transplant, may be an option for some patients, particularly those under 45 years old and in remission. A transplant involves replacing the patient's damaged bone marrow with healthy stem cells from a donor.
- Supportive care: Supportive care includes treatments to manage the side effects and complications of CML and its treatments. This may involve medications to manage pain, fever, nausea, and infections, as well as blood transfusions to replace damaged blood cells. It's important to discuss treatment options with your healthcare provider, as the appropriate treatment plan will depend on the individual's age, overall health, and the specific stage of the disease.
Preparing for medical consultation
To prepare for an appointment for chronic myelogenous leukemia (CML), follow these steps:
- Make an appointment with a hematologist, a specialist in the treatment of blood and bone marrow diseases and conditions.
- Be aware of any pre-appointment restrictions. Ask if there's anything you need to do in advance, such as restricting your diet or fasting before certain tests.
- Write down any symptoms you're experiencing, including those that may seem unrelated to CML.
- Make a list of key personal information, including major stresses, recent life changes, and family medical history.
- List all medications, vitamins, or supplements you are taking, including doses.
- Consider bringing a family member or friend to the appointment for support and to help remember important information.
- Prepare a list of questions to ask your hematologist, such as:
- Can you explain what my test results mean?
- Do you recommend any other tests or procedures?
- What is the phase of my CML?
- What are my treatment options?
- What side effects are likely with each treatment?
- How will treatment affect my daily life? Remember to be honest with your healthcare provider about your symptoms and concerns. This information will help them provide the best possible care and treatment for your chronic myelogenous leukemia.