Chronic Myeloid Leukemia

WHAT YOU SHOULD KNOW:

• Chronic myeloid leukemia (loo-KEE-mee-ah) is also called chronic myelogenous (mi-e-LOJ-e-nus) leukemia or CML. It is cancer of the bone marrow and blood cells. CML starts in the spongy red tissue inside your bones called bone marrow. The bone marrow makes stem cells. Stem cells become fully grown red blood cells (RBCs), white blood cells (WBCs) and platelets. Normally, stem cells grow to become blood cells in an orderly way and only as the body needs them.
  
  
• With CML, certain stem cells that should become WBCs do not fully grow. They act a little like WBCs, but do not fight infection like a normal WBC should. CML cells live longer than mature (fully grown) WBCs. They crowd the bone marrow and prevent normal blood cells from growing and doing their jobs correctly. If you have CML, you will need to get treatment as soon as possible. The type of treatment you have will depend on a number of things. These include your age, test results, general health, and phase (stage) of CML.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• CML is a serious medical problem. There are many risks with treatment. Chemotherapy and medicines used to treat CML may cause unpleasant side effects. Some common side effects are nausea (sick to your stomach), throwing up, and feeling very tired. Side effects also include diarrhea and having extra body fluid. You could have a bad reaction to a bone marrow or blood stem cell transplant.
  
  
• Treatment of CML may be slow to work, or may not work at all. CML may not go away or may get worse. If your CML goes into remission, it may return (relapse). CML may also spread to other parts of your body. If you do not have treatment, or the treatment does not work, you could die. With treatment your chances of controlling CML are better. Call your caregiver if you are worried or have questions about your medicine or care.

WHILE YOU ARE HERE:

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

Drinking liquids: Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). It is especially important to drink enough liquids if you are vomiting (throwing up) from chemotherapy. Follow your caregiver's advice if you must change the amount of liquids you drink. For most people, healthy liquids to drink are water, juices, and milk. If you are used to drinking liquids that contain caffeine, such as coffee, these can also be counted in your daily liquid amount. Try to drink enough liquid each day, and not just when you feel thirsty. It may be helpful to drink liquids between your meals instead of with your meals.

Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Sticky pads are placed on your chest or different parts of your body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. Do not remove any wires or sticky pads without asking your caregiver first.

Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.

Reverse isolation: You may be put on reverse isolation safety measures if your body is having a hard time fighting infections. You are given a private room to protect you from other people's germs. Caregivers and visitors may wear gloves, a face mask, or a gown to keep their germs away from you. Everyone should wash their hands when entering and leaving your room.

Medicines: You may be given medicines to treat problems caused by your AML. For example, you may be given antibiotics or other medicines to help your body fight infection. You may be given fever or pain medicine. You may take medicines to help you cope with chemotherapy side effects such as upset stomach or diarrhea.

Tests: You may need many different tests. The following are some common tests that may be done to help caregivers plan your treatment.

• Blood tests: You may need blood taken for tests. The blood may be taken from your IV, or from a vein in your hand, arm, or the bend in your elbow. Caregivers may do blood tests to count the number of each type of blood cell (RBCs, WBCs, platelets). They may do special test to learn more about the phase of CML that you have.
  
  
• Bone marrow biopsy: This is when a sample of bone marrow is removed and sent to a lab for tests. Bone marrow is the soft, spongy tissue inside the bone. The skin over your upper hipbone is first cleaned. Caregivers put numbing medicine into your skin so you will have little pain. A bandage is put on the biopsy area after the tissue sample is taken.

Treatments: Caregivers will decide which treatment is best for you. Your treatment may need to be changed one or more times if it is not working. Clinical trials (experimental treatments) may be offered. Caregivers may give you some of the following treatments alone or together:

• Blood transfusion: During a blood transfusion, you will get whole blood, or parts of blood through an IV. Many people are worried about getting AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus. If you refuse a blood transfusion, your condition may get worse, and you may die.
  
  
• CML medicines:
  
  
  • Kinase inhibitors: Kinase inhibitors may help decrease the growth of CML cells and increase the growth of normal blood cells.
    
    
  • Interferon: This medicine may help to decrease the growth of CML cells.
    
    
  • Chemotherapy: Chemotherapy, or "chemo," is medicine used to treat cancer. It works by killing cancer cells. It may be used together with other CML medicines. You may need it if the CML has spread. You may need chemo before having a bone marrow stem cell transplant. Chemo can have many side effects. You may be more likely to get infections or have other problems. Caregivers will watch you closely and will work with you to decrease the side effects. Even if the chemo does not cure your cancer, it may help you feel better or live longer.
  
  
• Radiation: This is a treatment that uses x-rays or gamma rays to kill cancer cells. You may have radiation treatments if the CML cells have spread to body organs such as your spleen and liver. They may be used to treat bone pain caused by CML. You may get radiation treatments before having a bone marrow or stem cell transplant.
  
  
• Transplants:
  
  
  • Bone marrow transplant (BMT): Your diseased bone marrow is replaced with healthy bone marrow. You are given bone marrow from someone else (a donor). The bone marrow transplant is given to you in an IV while you are in the hospital. A BMT may help cure you, but it can cause other very serious healthy problems. You may be in the hospital for a month or longer for a BMT.
    
    
  • Peripheral blood stem cell transplant (PBSCT): Bone marrow has many "stem cells" in it. The stem cells are the part of the bone marrow that make or change into blood cells. During a PBSCT, stem cells are put into your body. For this process, stem cells are removed from donated blood, and then put into your body through an IV. The stem cells should go into your bone marrow. Once in the bone marrow, stem cells can grow and become blood cells.
    
    
  • Contact the following organization for more information about transplants:
    • National Marrow Donor Program
      3001 Broadway Street NE, Suite 500
      Minneapolis, MN 55413-1753
      Phone: 1-800-627-7692
      Web Address: http://www.marrow.org
      

Venous access device: An IV catheter or tube may be placed in a large vein (blood vessel) near your collarbone, in your neck, or in your arm. Some examples of these venous access devices are Hickman. Groshong, and PICC lines. You may also have a port, which is a type of venous access device that is placed under the skin and connected to a large vein. You may need a venous access device to receive chemotherapy, other medicines and fluids that need to be given through a big vein. A venous access device can stay in longer than a regular IV can. You may need this device to receive chemotherapy treatments.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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