A patient remembers the day he was diagnosed. Writing on a patient support group forum, he recalls, "I had one of the first oncologists I saw tell me 'you got the cancer I can treat. One pill a day and you carry on. Who's luckier than you?'"
Of course, having cancer isn't a lucky fate for anyone. However, chronic melogenous leukemia is one of the more treatable and curable cancers.
What is chronic melogenous leukemia?
Chronic melogenous leukemia - or CML - involves the bone marrow and how blood cells are made there.
It's a slow-growing cancer in which too many white blood cells are produced. CML has other names, including:
- Chronic myeloid
- Chronic granulocytic
- Chronic myelocytic leukemia
Other facts about CML:
- CML is one of four main types of leukemia.
- Hematologists and oncologists are specialists who treat people living with CML
- Most CML patients are treated with daily oral medications
While CML is a common type of leukemia, overall it's an uncommon form of cancer, with less than 5,000 cases diagnosed a year. It's most commonly seen in people over the age of 55 and rarely in children.
What causes CML?
Our cells each have different genetic codes. With CML, bone marrow cells get confused. Parts of two different chromosomes (9 and 22) switch places. This produces what's known as the Philadelphia chromosome, an abnormal chromosome that tells the bone marrow to produce too many immature and non-functioning white blood cells.
No one knows why the Philadelphia chromosome appears. It is known, though, that the chromosome is not passed from parent to child.
What are the symptoms of CML?
Like so many other conditions, CML symptoms can signal other diseases. These are the most common problems that should be checked out by a doctor:
- Fatigue - feeling really tired
- Weight loss - without dieting
- Pain or feeling of fullness below the ribs on the left side caused by an enlarged spleen
- Night sweats
- Fever
And some people with CML don't have any symptoms.
How is CML diagnosed?
After a health history is taken, these tests are usually ordered:
- Complete blood count (CBC) to check the number of different types of blood cells present
- Blood chemistry studies to see if there are any unusual levels of substances in the blood
- Cytogenetic analysis that looks for changes in chromosomes and the presence of the Philadelphia chromosome
- Bone marrow aspiration and biopsy in which bone marrow, blood and bone samples are gathered and analyzed to look for abnormal cells.
These tests may be repeated to determine what type or stage of CML it is.
What are the different stages of CML?
Chronic myelogenous leukemia has 3 phases.
Chronic phase
This is the earliest stage of the disease during which there are more white blood cells and bone marrow than usual.This phase can be diagnosed through routine blood tests that show too many white blood cells.
- This phase used to last 2-5 years before progressing to a more serious phase
- Gleevec (imatinib mesylate) has changed that so many people don't get worse
- CML is usually diagnosed in its chronic phase when treatment is very effective for most patients
Accelerated phase
At this stage, the body has more immature (not fully formed) white blood cells called blast cells in the blood, marrow, liver and spleen.
- Blasts can't fight infections the way normal white blood cells do
- This phase used to last only 1-6 months before progressing
- Drug treatments can delay progression to more than a year
Blast phase
The most advanced stage of CML, during the blast phase, blast cells grow rapidly in the bloodstream.
- Fewer healthy, normal blood cells are present
- Symptoms are more serious and can include bruising, bleeding and infection
- At this stage, the disease resembles more serious types of leukemia
How is CML treated?
Fortunately, CML has a number of treatment options. Most people begin by taking medication. In more severe cases, surgery to remove the spleen may be required. Transplants are also an option that actually offer a cure.
Medications
A medicine called Gleevec (imatinib) is usually the first treatment for everyone with CML. Here are some things to know about this medication:
- Gleevec is a pill that's taken once a day by mouth
- Known as a targeted therapy, it identifies and attacks the bad cells without harming normal cells
- It's in a class of drugs known as tyrosine kinase inhibitors
- On the market for more than a decade, Gleevac has revolutionized the treatment of CML
- Most people tolerate its side effects well
- It is associated with very high rates of remission and survival
- About 80 percent of patients treated with Gleevec remain stable, not getting worse or better
For some patients, though, Gleevec doesn't work or loses its effectiveness. When this happens, two other medications are available:
For more difficult cases, the following medicines may be prescribed:
- Bosutinib (formerly known as SKI-606)
- Omapro (Omacetaxine Mepusuccinate)
- Ponatinib (AP24534)
Sometimes a chemotherapy medicine called Hydrea (hydroxyurea) is used temporarily to reduce the white blood cell count if it is very high when CML is diagnosed.
Transplants
The only known cure for CML is a bone marrow transplant or stem cell transplant. These are both major procedures that carry a number of risks, including death. Such options should carefully considered and talked about in detail with physicians.
Clinical trials
Clinical trials are studies looking for new treatments of a number of diseases, including CML. To learn more about these options, click on the "Finding a Clinical Trial" link below.
The Outlook
CML does have a number of excellent treatment options that help people living with the disease. Medications stabilize the disease in 80 percent of the cases.
Transplant operations, though rigorous, can also provide a cure.
Is it really an "easy cancer" though?
"It helps to put our CML treatment in perspective - 1 pill, once a day instead of other cancers where chemo &/or radiation &/or surgery are the only options," writes a patient on a support forum.
