What is chronic myelogenous leukemia?
The bone marrow plays a pivotal role in the production of blood cells for the body’s ability to defend itself. In a healthy individual, the bone marrow generates stem cells, which subsequently mature into white blood cells, red blood cells or platelets that circulate throughout the bloodstream. Leukemia develops due to abnormalities in these stem cells, resulting in the unregulated proliferation of white blood cells that circulate in the bloodstream.
Chronic myeloid leukemia (CML), also known as chronic granulocytic leukemia or chronic myelogenous leukemia is an uncommon type of cancer in the bone marrow. This type of leukemia can affect almost anyone but is most commonly found in middle aged adults and affects the white blood cells called myeloid cells. The overproduction of immature myeloid cells, which are known as blasts, prevents the bone marrow from producing healthy blood cells of all types.
Myeloid cells, a category of white blood cells, include granulocytes, monocytes, macrophages and dendritic cells, any of which have the potential to lead to the development of chronic myeloid leukemia when found in abnormal amounts.
CML Risk Factors
- Age: The average age a person can be diagnosed with CML is around 64. This cancer is very uncommon among children and teens.
- Radiation exposure: Many people who were around the 1945 atomic bombings in Japan were diagnosed with CML. Additionally, a condition known as ankylosing spondylitis often treated with radiation therapy has been linked with CML. Otherwise, there are no known links to CML caused by radiation or chemotherapy.
- Gender: Men are more likely to develop CML than women.
- The Philadelphia Chromosome: Nearly all CML patients have the Philadelphia chromosome which develops after birth and can be detected only with a specific test for this genetic abnormality.
CML Symptoms
- Fatigue
- Shortness of breath during normal physical activity
- Dull or pale skin
- Feeling full or discomfort in left upper abdomen due to an enlarged spleen
- Drenching night sweats
- Fever
- Unexplained and dramatic weight loss
- Bone pain
- Loss of appetite
- Bleeding easily
CML Diagnosis
- Complete blood count (CBC) with differential: This test will provide current red blood cell counts, white blood cell counts, platelet counts and hemoglobin levels within red blood cells. The differential analysis will specifically categorize the various types of white blood cells. People with CML often have a dramatically high white blood cell count, a decreased red blood cell count and either an increase or decrease in the platelet count (depending on the severity of their CML).
- Peripheral blood smear: This is a technique doctors use to examine your red and white blood cells as well as your platelets to provide status of health of your blood.
- Bone marrow aspiration and biopsy: The doctor will collect and examine bone marrow to see whether your bone marrow is healthy and functioning properly or not.
- Cytogenetic analysis: Special stains are applied to the bone marrow and then the cells are observed to detect any abnormalities in chromosomal structure, such as the Philadelphia chromosome.
- Fluorescence in situ hybridization (FISH): Laboratory test used to examine genes and chromosomes in cells and much more effective diagnostic method than cytogenetic testing.
- Quantitative polymerase chain reaction (qPCR): The most sensitive test used to detect and measure the quantity of BCR:ABL1 gene in blood or bone marrow samples.
Treatment Options for CML
- Chemotherapy: Interferes with the leukemia cells ability to multiply and grow.
- Targeted therapy: This utilizes drugs and other substances that are able to recognize and attack cancer cells without harming healthy cells.
- Radiation therapy: This therapy is most commonly used in which high-energy rays are used to damage or even kill cancer cells and shrink tumors.
- Bone marrow transplant: This is often recommended after a patient with a damaged bone marrow. Once the patient enters remission, they are given new bone marrow from a donor.
- CAR-T cell therapy (patients with ALL): This is an innovative form of immunotherapy where a patient’s T-cells are reprogrammed at Sheba’s in-house lab and then transplanted back into the patient to target the cancer cells.
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