Key points of this article:
- Chronic myeloid leukemia (CML), also known as chronic myeloid leukemia or chronic myeloid leukemia, is a neoplasm that affects the patient’s blood cells and bone marrow.
- CML is a slowly progressive tumor and although it is difficult to cure completely, most patients can achieve long-term survival.
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With treatment, patients can go into disease remission. However, for most patients, this does not mean that the tumor is completely cured, but only that the disease is less active than before. In some patients, the period of disease remission can last for many years.
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CML occurs in the middle-aged or older population, and symptoms will appear gradually. Many of the symptoms are similar to those of other diseases, such as fatigue, unexplained weight loss, and sometimes fever.
- The root causes of CML are
The root cause of CML development is a genetic variation in blood cells. A region on two different chromosomes in the patient crosses over and interchanges, creating an abnormal chromosome (the Philadelphia chromosome). This newly formed abnormal chromosome causes the patient’s body to produce abnormal white blood cells, called leukemia cells. When they are present in the bloodstream, they crowd out the normal blood cells.
Etiology
Most patients are not sure what causes them to develop chronic granulocytic leukemia. Patients with the disease do not usually develop it through heredity or infection. Patients’ smoking and dietary habits also do not affect the risk of disease.
The current known risk factor is exposure to high levels of radiation.
Symptoms
There are three stages of chronic granulocytic leukemia: the chronic phase, the accelerated phase, and the acute phase. The symptoms a patient experiences depend on the stage the disease is in.
Chronic stage
The earliest stage, and the easiest to treat, patients may often have no significant symptoms.
Accelerated phase
The number of abnormal blood cells increases and patients may experience the following symptoms:
- extreme fatigue;
- fever;
- Bruising;
- night sweats;
- shortness of breath;
- weight loss;
- loss of appetite;
- swelling and pain in the upper left side of the body in the thoracic and lumbar region (a possible sign of an enlarged spleen);
- Bone pain.
Other symptoms may include stroke, vision changes, ringing in the ears, dizziness, and prolonged erection of the penis.
Acute phase
The number of leukemic cells increases exponentially, suppressing normal blood cells and platelets. During this stage, patients develop more severe symptoms such as:
- Infection;
- bleeding;
- skin changes with lumps and tumors;
- swollen lymph nodes;
- Bone pain.
Diagnosis
Patients may be seen by a physician who asks the following questions:
- What symptoms are present?
- How long have the symptoms lasted?
- Are the symptoms persistent, or intermittent?
- When do you feel better or worse?
- Are you taking any medications?
To confirm the diagnosis, the doctor will also perform additional tests on the patient, such as:
- Full blood count: Checking the number of white blood cells, red blood cells, and platelets in the blood.
- Bone marrow test: Determines the extent of the patient’s tumor progression. The doctor uses a syringe to take a sample from the patient’s iliac bone.
- FISH test (fluorescence in situ hybridization): The laboratory test provides detailed information about the patient’s genetic changes.
- Ultrasound or CT scan: This can be used to examine the size of the patient’s spleen. Ultrasound uses ultrasound to visualize, and CT uses X-rays to take a series of pictures of the patient’s body.
- Polymerase chain reaction (PCR) tests, in which the laboratory detects the presence of the BCR-ABL gene, which is involved in the process of massive proliferation of abnormal white blood cells.
Treatment
The goal of treatment is to kill the leukemia cells in the patient’s body and restore the values of healthy blood cells to normal levels. However, it is unlikely that all abnormal cells will be removed.
If patients receive early treatment, which starts in the chronic phase of chronic granulocytic leukemia, it can help prevent progression to more severe subsequent stages.
Doctors usually start with a drug called tyrosine kinase inhibitors (TKIs) to reduce the percentage of leukemic cells in the patient’s body.
Commonly used tyrosine kinase inhibitors include:
- Bosutinib (bosutinib)
- dasatinib (dasatinib)
- Imatinib (imatinib)
- Nilotinib (nilotinib)
If the above tyrosine kinase inhibitors are not effective or if the patient cannot tolerate the drug, drugs such as panatinib (ponatinib) may also be tried.
Patients whose disease continues to worsen after trying 2 or more tyrosine kinase inhibitors may be advised to use hypertriglyceride.
Other options for treating chronic granulocytic leukemia include chemotherapy and biologic therapy, which involves the use of interferons to help strengthen the immune system.
Some patients can be cured with a stem cell transplant. This treatment process is complex and is usually used when other treatment options have failed. Patients may have heard of “stem cells” in many news articles, but most stem cells in this context refer to “embryonic” stem cells used in cloning technology. The “stem cells” in a stem cell transplant are the bone marrow stem cells in the human bone marrow that produce blood cells.
If a patient has a stem cell transplant, a donor is needed to provide fresh stem cells. Patients need to register on a waiting list to find a matched stem cell donor, thus reducing the rejection of the transplanted cells by the patient’s immune system.
A patient’s next of kin, such as a sibling, is most likely to be a successful match for the patient. If the match fails, there is a waiting list for a volunteer to donate stem cells. The most suitable stem cell donor for the patient is usually from the same ethnic background.
Everyday
Patients must inform their doctors of all medications they take because certain medications should not be mixed with those for chronic granulocytic leukemia.
Patients should follow their doctor’s treatment plan, eat a healthy diet, and exercise moderately if they are physically able to do so.