Consumer Information

Chronic Myeloid Leukemia

GENERAL INFORMATION:

What is it? 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. Adults usually get it, but it may occur in children too. If you have CML, you will need to get treatment as soon as possible. Treatment will depend on a number of things. These include your age, health, and how many CML cells are in your bone marrow and blood. Your treatment also depends on whether the CML has spread to other parts of your body.

How is blood normally made by the body? Bone marrow is the spongy red tissue inside your bones. The bone marrow makes stem cells. Stem cells become fully grown red blood cells (RBCs), white blood cells (WBCs) and platelets. RBCs carry oxygen to all the organs and tissues of your body. WBCs help your body fight infection by attacking and killing germs. Platelets stop the bleeding when you are cut or injured. Stem cells grow to become blood cells in an orderly way and only as the body needs them.

How does CML change the way blood is made? With CML, certain stem cells that should become WBCs do not fully grow. These CML cells 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. CML can spread from the bone marrow and blood to the spleen, liver, and other parts of the body. It can also turn into an "acute" or fast growing form of leukemia.

What causes CML? Most people with CML have a change in their 9th and 22nd chromosomes (tiny strings of DNA). When this change occurs, they have a Philadelphia chromosome. This is not normal. The Philadelphia chromosome causes stem cells to make CML cells instead of normal WBCs. Whether or not you have the Philadelphia chromosome, you may be at higher risk of having CML if:

You have been exposed to high amounts of radiation.
You are male. CML is more common in men than women.
You are an aging adult. CML is most common in people between 50 to 60 years of age.

What are the signs and symptoms of CML? At first, you may have no signs or symptoms of CML. Many people learn that they have CML after having blood drawn for tests during a regular medical exam. If you have signs and symptoms, they may include one or more of the following:

Fullness or discomfort in your stomach because of a swollen spleen or liver. This is also called spleenomegaly.
Fatigue (feeling tired), weakness that does not go away, and pale skin.
Fever.
Infections, such as the cold or flu, do not get better or keep coming back.
Losing weight without trying.
Shortness of breath, or you become easily tired during normal amounts of exercise.
Sweating more than usual. You may also have night sweats.
Less common signs and symptoms are painful bones and joints, and bruising and bleeding more easily.

How is CML diagnosed? You will need blood tests to count the number of each type of blood cell (RBCs, WBCs, platelets). You may also have a bone marrow biopsy. During a bone marrow biopsy, a needle is put into a bone in your hip. A small amount of bone marrow is taken out. Caregivers will use a microscope and do special tests to look at the blood and bone marrow samples. These tests help caregivers to learn which phase (stage) of CML you have. Knowing the number of blood cells and phase of leukemia will also help caregivers plan your treatment. Caregivers may do other tests to look for infection or see if your CML has spread.

What are the phases of CML?

Chronic phase: People with chronic phase CML have few signs and symptoms. The CML cells are in the blood and bone marrow, but have not spread to other parts of the body. This is usually the easiest phase to treat.
Accelerated phase: People in this phase have more signs and symptoms. They have more CML cells in their blood and bone marrow. Usually, the CML cells have not spread to other parts of the body. This phase is often more difficult to treat than the chronic phase. You may need to try a number of different types of treatment to find one that works.
Blast phase: People in this phase have many more CML cells in their blood and bone marrow. The CML cells have usually spread to other parts of the body such as the spleen and liver. The CML may have turned into a fast-growing leukemia.

How is CML treated? Your caregiver will decide which treatment is best for you. Your treatment may be changed if it is not working. Clinical trials (experimental treatments) may be offered. You may need one or more of the following treatments:

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 treat CML by decreasing the growth of CML cells.
- Chemotherapy: Chemotherapy, or "chemo," is cancer-fighting medicine. It may be used together with other CML medicines or added as a treatment if your cancer has spread. You may also need it before having a stem cell transplant. Two or more chemo medicines may be used together to treat CML.
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: You may have a bone marrow or blood stem cell transplant. During a transplant, bone marrow or stem cells are put in your blood through an IV. The bone marrow or stem cells should go to your bone marrow and begin making healthy, new blood cells.

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.

For support and information:

Accepting that you have CML is hard. You and those close to you may feel scared, depressed, angry, or sad. These are normal feelings. Talk to your caregivers, family, or friends about your feelings. You may also want to join a cancer support group.
For more information you may contact:

American Cancer Society
Phone: 1-800-227-2345
Web Address: http://www.cancer.org

National Cancer Institute
Phone: 1-800-422-6237
Web Address: http://www.cancer.gov

The Leukemia & Lymphoma Society Inc.
1311 Mamaroneck Avenue
White Plains, NY 10605
Phone: 1-914-949-5213
Phone: 1-800-955-4572
Web Address: http://www.leukemia-lymphoma.org

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.

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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