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Chronic myelogenous leukemia (CML)

CML; Chronic myeloid leukemia; Chronic granulocytic leukemia; Leukemia - chronic granulocytic

 

Chronic myelogenous leukemia (CML) is cancer that starts inside bone marrow. This is the soft tissue in the center of bones that helps form all blood cells.

CML causes an uncontrolled growth of immature and mature cells that make a certain type of white blood cell called myeloid cells. The diseased cells build up in the bone marrow and blood.

Causes

 

Cause of CML is related to an abnormal chromosome called the Philadelphia chromosome.

Radiation exposure can increase the risk of developing CML. Radiation exposure can be from radiation treatments used in the past to treat thyroid cancer or Hodgkin lymphoma or from a nuclear disaster.

It takes many years to develop leukemia from radiation exposure. Most people treated for cancer with radiation do not develop leukemia. And most people with CML have not been exposed to radiation.

CML most often occurs in middle-age adults and in children.

 

Symptoms

 

Chronic myelogenous leukemia is grouped into phases:

  • Chronic
  • Accelerated
  • Blast crisis

The chronic phase can last for months or years. The disease may have few or no symptoms during this time. Most people are diagnosed during this stage, when they have blood tests done for other reasons.

The accelerated phase is a more dangerous phase. Leukemia cells grow more quickly. Common symptoms include fever (without infection), bone pain, and a swollen spleen.

Untreated CML leads to the blast crisis phase. Bleeding and infection may occur due to bone marrow failure.

Other possible symptoms of a blast crisis include:

  • Bruising
  • Excessive sweating (night sweats)
  • Fatigue
  • Fever
  • Pressure under the lower left ribs from a swollen spleen
  • Rash - small pinpoint red marks on the skin (petechiae)
  • Weakness

 

Exams and Tests

 

A physical examination often reveals a swollen spleen. A complete blood count (CBC) shows an increased number of white blood cells with many immature forms present and an increased number of platelets. These are parts of the blood that help blood clot.

Other tests that may be done include:

  • Bone marrow biopsy
  • Blood and bone marrow testing for the presence of the Philadelphia chromosome
  • Platelet count

 

Treatment

 

Medicines that target the abnormal protein made by the Philadelphia chromosome are often the first treatment for CML. These medicines can be taken as pills.

Sometimes, chemotherapy is used first to reduce the white blood cell count if it is very high at diagnosis.

The blast crisis phase is very difficult to treat. This is because there is a very high count of immature white blood cells (leukemia cells).

The only known cure for CML is a bone marrow transplant, or stem cell transplant. Most people, though, do not need a transplant because the targeted medicines are successful. Discuss your options with your oncologist.

You and your health care provider may need to manage many other issues or concerns during your leukemia treatment, including:

  • Managing your pets during chemotherapy
  • Bleeding problems
  • Eating enough calories when you are sick
  • Swelling and pain in your mouth
  • Safe eating during cancer treatment

 

Support Groups

 

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

 

Outlook (Prognosis)

 

Targeted medicines have greatly improved the outlook for people with CML. When the signs and symptoms of CML go away and blood counts and bone marrow biopsy appear normal, the person is considered in remission. Most people can remain in remission for many years while on this medicine.

Stem cell or bone marrow transplant is often considered in people whose disease comes back or gets worse while taking the initial medicines. Transplant may also be recommended for people who are diagnosed in accelerated phase or blast crisis.

 

Possible Complications

 

Blast crisis can lead to complications, including infection, bleeding, fatigue, unexplained fever, and kidney problems. Chemotherapy can have serious side effects, depending on the drugs used.

 

Prevention

 

Avoid exposure to radiation when possible.

 

 

References

Kantarjian H, Cortes J. Chronic myeloid leukemia. In: Niederhuber JE, Armitage JO, Doroshow JH, et al, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier; 2014:chap 101.

National Cancer Institute: PDQ chronic myelogenous leukemia treatment. Bethesda, MD: National Cancer Institute. Updated March 9, 2016. www.cancer.gov/cancertopics/pdq/treatment/CML/HealthProfessional. Accessed March 17, 2016.

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: chronic myelogenous leukemia. Version 1.2016. www.nccn.org/professionals/physician_gls/pdf/cml.pdf. Accessed March 17, 2016.

 
  • Bone marrow aspiration

    Bone marrow aspiration - illustration

    A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some storage diseases, in which abnormal metabolic products are stored in certain bone marrow cells.

    Bone marrow aspiration

    illustration

  • Auer rods

    Auer rods - illustration

    Note multiple Auer rods which are found only in acute myeloid leukemias, either myeloblastic or monoblastic. These rods consist of clumps of azurophilic granule material.

    Auer rods

    illustration

  • Chronic myelocytic leukemia - microscopic view

    Chronic myelocytic leukemia - microscopic view - illustration

    This high-power microscopic view of a blood smear from a person with classical CML shows predominantly normal-appearing cells with intermediate maturity.

    Chronic myelocytic leukemia - microscopic view

    illustration

  • Chronic myelocytic leukemia

    Chronic myelocytic leukemia - illustration

    Oil immersion field demonstrating myeloid cells of all degrees of maturity.

    Chronic myelocytic leukemia

    illustration

  • Chronic myelocytic leukemia

    Chronic myelocytic leukemia - illustration

    Low power view showing marked hypercellularity with a broad-spectrum of myeloid and erythroid cell types and marked myeloid hyperplasia.

    Chronic myelocytic leukemia

    illustration

  • Antibodies

    Antibodies - illustration

    Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.

    Antibodies

    illustration

    • Bone marrow aspiration

      Bone marrow aspiration - illustration

      A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some storage diseases, in which abnormal metabolic products are stored in certain bone marrow cells.

      Bone marrow aspiration

      illustration

    • Auer rods

      Auer rods - illustration

      Note multiple Auer rods which are found only in acute myeloid leukemias, either myeloblastic or monoblastic. These rods consist of clumps of azurophilic granule material.

      Auer rods

      illustration

    • Chronic myelocytic leukemia - microscopic view

      Chronic myelocytic leukemia - microscopic view - illustration

      This high-power microscopic view of a blood smear from a person with classical CML shows predominantly normal-appearing cells with intermediate maturity.

      Chronic myelocytic leukemia - microscopic view

      illustration

    • Chronic myelocytic leukemia

      Chronic myelocytic leukemia - illustration

      Oil immersion field demonstrating myeloid cells of all degrees of maturity.

      Chronic myelocytic leukemia

      illustration

    • Chronic myelocytic leukemia

      Chronic myelocytic leukemia - illustration

      Low power view showing marked hypercellularity with a broad-spectrum of myeloid and erythroid cell types and marked myeloid hyperplasia.

      Chronic myelocytic leukemia

      illustration

    • Antibodies

      Antibodies - illustration

      Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.

      Antibodies

      illustration

    A Closer Look

     

    Talking to your MD

     

      Self Care

       

        Tests for Chronic myelogenous leukemia (CML)

         

         

        Review Date: 2/1/2016

        Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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