About

Chronic Myelogenous Leukemia (CML)


About Chronic Myelogenous Leukemia (CML)

Chronic myelogenous leukemia, also known as chronic myeloid leukemia, is a type of cancer that originates in the blood-forming cells of the bone marrow and leads to the production of too many mature white blood cells. It is relatively slow growing, although sometimes CML transforms into a rapidly growing acute leukemia.

Approximately 15% of all cases of leukemia in adults are CML, and about half of these patients are 65 years old or older. According to the American Cancer Society, about 8,000 new cases are diagnosed annually in the United States.


People who have CML develop an abnormality during their lifetime that leads to a short chromosome, called the Philadelphia chromosome. This short chromosome changes a specific gene (BCR-ABL) so that it functions defectively – acting as an “on switch” to trigger the overgrowth of granulocytes, a type of white blood cell. Once these CML granulocytes multiply and accumulate in the blood and bone marrow, there is not enough room for healthy blood cells to grow. Over time, the leukemia cells migrate from the bone marrow and settle in other organs too, such as the spleen.

Chronic myelogenous leukemia is “chronic” because the cells mature partially (not fully), and live longer than normal cells. It can take a while before this type of leukemia causes any problematic symptoms, however, chronic leukemias are also generally more difficult to treat.

There are only a few proven risk factors for CML:

  • Radiation exposure: being exposed to high doses of radiation (such as surviving an atomic bomb explosion)
  • Age: your risk of CML increases with age
  • Being male: CML is slightly more common in men than in women; the reason is unknown

CML does not run in families, and the risk does not appear to be affected by diet, exposure to chemicals, infection, or smoking.

Chronic myelogenous leukemia is a disease of the bone marrow and does not form tumors, so it can’t be staged in the same manner as most types of cancer. Rather, CML is assessed based on the three general phases of the disease. These phases are defined primarily on the quantity of immature white blood cells, called blasts, in the bone marrow or blood.

According to definitions set by the World Health Organization, these are the three phases of CML:

  1. Chronic phase: patients in this phase usually have less than 10% blasts in their bone marrow or blood samples.
  2. Accelerated phase: during this phase, blood and bone marrow samples usually have 15% or more blasts, but less than 30%. Platelet counts are generally very low, and new chromosome changes in the leukemia cells with the Philadelphia chromosome are typically exhibited.
  3. Blast phase: samples of blood and/or bone marrow usually have 20% or more blasts, and large clusters of blasts are present in the bone marrow. These blast cells have spread to other organs and tissues. When fever, fatigue, and an enlarged spleen are present, it is categorized as a blast crisis.

The symptoms of CML vary depending on the phase of the disease that a person is in. During the chronic phase, a person may not experience any symptoms. Yet once a patient enters the accelerated phase of CML, the increased number of blasts leads to various symptoms, including:

  • Tiredness and fatigue
  • Fever
  • Easy bruising
  • Night sweats
  • Shortness of breath
  • Weight loss
  • Reduced appetite
  • Swelling or pain on the left side
  • Bone pain

The blast phase is often accompanied by extreme symptoms, such as:

  • Bleeding
  • Infections
  • Skin changes; tumors and bumps
  • Severe bone pain
  • Swollen glands

What is CML?

People who have CML develop an abnormality during their lifetime that leads to a short chromosome, called the Philadelphia chromosome. This short chromosome changes a specific gene (BCR-ABL) so that it functions defectively – acting as an “on switch” to trigger the overgrowth of granulocytes, a type of white blood cell. Once these CML granulocytes multiply and accumulate in the blood and bone marrow, there is not enough room for healthy blood cells to grow. Over time, the leukemia cells migrate from the bone marrow and settle in other organs too, such as the spleen.

Chronic myelogenous leukemia is “chronic” because the cells mature partially (not fully), and live longer than normal cells. It can take a while before this type of leukemia causes any problematic symptoms, however, chronic leukemias are also generally more difficult to treat.

 

What are the Risk Factors for CML?

There are only a few proven risk factors for CML:

  • Radiation exposure: being exposed to high doses of radiation (such as surviving an atomic bomb explosion)
  • Age: your risk of CML increases with age
  • Being male: CML is slightly more common in men than in women; the reason is unknown

CML does not run in families, and the risk does not appear to be affected by diet, exposure to chemicals, infection, or smoking.

 

What are the Phases of CML?

Chronic myelogenous leukemia is a disease of the bone marrow and does not form tumors, so it can’t be staged in the same manner as most types of cancer. Rather, CML is assessed based on the three general phases of the disease. These phases are defined primarily on the quantity of immature white blood cells, called blasts, in the bone marrow or blood.

According to definitions set by the World Health Organization, these are the three phases of CML:

  1. Chronic phase: patients in this phase usually have less than 10% blasts in their bone marrow or blood samples.
  2. Accelerated phase: during this phase, blood and bone marrow samples usually have 15% or more blasts, but less than 30%. Platelet counts are generally very low, and new chromosome changes in the leukemia cells with the Philadelphia chromosome are typically exhibited.
  3. Blast phase: samples of blood and/or bone marrow usually have 20% or more blasts, and large clusters of blasts are present in the bone marrow. These blast cells have spread to other organs and tissues. When fever, fatigue, and an enlarged spleen are present, it is categorized as a blast crisis.

 

What are the Symptoms of CML?

The symptoms of CML vary depending on the phase of the disease that a person is in. During the chronic phase, a person may not experience any symptoms. Yet once a patient enters the accelerated phase of CML, the increased number of blasts leads to various symptoms, including:

  • Tiredness and fatigue
  • Fever
  • Easy bruising
  • Night sweats
  • Shortness of breath
  • Weight loss
  • Reduced appetite
  • Swelling or pain on the left side
  • Bone pain

The blast phase is often accompanied by extreme symptoms, such as:

  • Bleeding
  • Infections
  • Skin changes; tumors and bumps
  • Severe bone pain
  • Swollen glands

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