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Chronic Myelogenous Leukemia

DEFINITION

Chronic Myelogenous Leukemia (CML) is one of several types of cancer of the cells in the blood and bone marrow (the tissue in the center of bones which makes blood). CML is a cancer where blood cells reproduce in an uncontrolled manner. DNA normally controls how the cells grow and reproduce. In CML, the DNA of these cells has a mutation that allows them to grow and reproduce at a very high rate. In CML, this change occurs when two different pieces of DNA called chromosomes swap places, numbers 9 and 22. The changed chromosome is called the Philadelphia chromosome where a newly created gene called BCR-ABL is housed. Due to this change, instead of dying like a normal cell would, these cells divide more frequently and live a particularly long time. Normal, healthy blood cells which are usually produced in the bone marrow get crowded and no longer can reproduce normally. “Chronic” in the name of the disease refers to the disease coming on and progressing more slowly. “Myelogenous” refers to the type of blood cells which grow out of control in this disease, myeloid cells, a type of white blood cell which grows up to become other blood cells. “Leukemia” refers to this being a cancer of white blood cells. CML has three stages: chronic (the first stage which usually responds best to treatment), accelerated (transition stage where the cancer becomes faster growing and more aggressive), and blastic (which is very severe and aggressive and can cause death). CML generally affects adults, but can happen at any age. Risk factors for CML include: being older, being a man, and having previous exposure to radiation. Surprisingly, having a family member with CML does not make you more likely to get CML. Complications of CML include fatigue (due to decreased blood counts), risk of bleeding (due to decreased platelets), pain (especially in the bones and joints), large spleen (from storage of extra blood cell products), increased risk of stroke (if you have too many instead of too few platelets), increased infections (due to decreased numbers of functioning white blood cells), and death.

SYMPTOMS
Fatigue, fever, easy bleeding, frequent or recurring infections, weight loss, decreased appetite, pale color of the skin, night sweats

DIAGNOSIS
Your doctor will begin with talking to you about your symptoms and doing a thorough physical exam. The diagnosis of CML is ultimately made by checking several tests. First, a blood sample is taken which may show too many white blood cells and specific types of blood cells. This blood test can also show too few red blood cells or platelets (the other cells that come from the bone marrow). If a problem with the blood (like leukemia) is suspected, a procedure is done to look at the bone marrow called a bone marrow biopsy. The biopsy involves making a small hole with a needle in part of the hip bone to take out bone marrow cells. This procedure is used to diagnose the cancer and to follow how the bone marrow is doing with treatment. Your oncologist (cancer doctor) may also want to do specialized testing for the Philadelphia chromosome called fluorescence in situ hybridization (FISH) or polymerase chain reaction (PCR). Your oncologist may want to do some additional testing like taking X-rays or CT scan pictures of the body to determine if and to where the cancer has spread.

TREATMENT
Treatment of CML depends in large degree to the stage and general health. CML can be treated with targeted drugs, chemotherapy, biological therapy, and bone marrow transplant. Targeted therapy is a good option for CML because of the presence of the Philadelphia chromosome and the BCR-ABL gene. These targeted therapies include imatinib (Gleevec), dasatinib (Sprycel), and nilotinib (Tasigna). Targeted therapies are usually continued even after the cancer has gone into remission. Chemotherapy is medications taken for cancer which are available for CML. These medications are taken by mouth or through an intravenous (IV) line. Biologic therapies available for CML include interferon which can help reduce the growth of the cancerous cells by enlisting the help of your body’s immune system. When other treatments are not successful, bone marrow transplant can be used to treat CML. Chemotherapy or radiation is used to get rid of the cancerous cells in the bone marrow followed by returning other bone marrow cells to that marrow to create new, healthy bone marrow. The donor for the bone marrow can either be someone else or the patient’s own marrow if it is harvested in a time when their cancer is in remission. Bone marrow biopsy is usually a last resort because the side effects of the treatment can be severe. You should discuss your treatment options with your doctor or oncologist.

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