CML in Children and Young Adults
Chronic myeloid leukemia, more commonly known as simply CML, is a rare type of blood cancer (leukemia). CML develops when the immature white blood cells in the bone marrow, known as myeloid cells, grow and develop at an abnormal rate.
When this happens, the myeloid cells crowd out the normal and mature blood cells and this leads to various complications. While medical professionals still aren’t sure what exactly causes this white blood cell overproduction, it is known that it’s linked to a genetic mutation known as the Philadelphia chromosome.
CML most commonly affects adults and is very rarely seen in children, but just because it’s rare that doesn’t mean that it’s unheard of. Chronic myeloid leukemia accounts for approximately 3% of all leukemia cases diagnosed in children.
Chronic myeloid leukemia has three different and distinct phases: chronic phase, accelerated phase, and blast or acute phase.
This disease is very distinctive and for anyone looking to understand it properly, we need to go through the different symptoms patients who suffer from CML display, and all the available treatment options.
Pediatric CML Signs and Symptoms
Chronic myeloid leukemia presents a variety of symptoms in both adults and children. Since this is such a rare disease in children, it’s important to note that symptoms vary from one patient to another and that CML can sometimes also be completely asymptomatic.
That being said, there are some common symptoms children with CML display. They include:
- Constantly feeling fatigued and weak, with no explanation, and throughout all times of the day. This fatigue can interfere with the child’s daily activities and normal everyday life.
- Easy bruising with all kinds of injuries, even mild ones.
- Unexplained bone pain that occurs all over the body, but especially in the legs and other long bones.
- Severe night chills and sweats that often interrupt the child’s sleep.
- Unexplained and significant weight loss.
- Abdominal pain and discomfort.
- Pale skin caused by anemia and otherwise abnormal blood counts.
- A high and persistent fever.
It’s important to remember that these symptoms aren’t exclusive to CML and a child suffering from these symptoms doesn’t necessarily have chronic myeloid leukemia.
Pediatric CML Diagnosis
Even though displaying the aforementioned symptoms doesn’t mean that the child is suffering from CML, it’s still vital to take them to the doctor to get a proper diagnosis.
There are a couple of different tests the doctor will do if they suspect the presence of pediatric CML.
When suspecting leukemia, blood tests are always necessary. The doctor will want to perform two types of blood tests:
- A complete blood count (CBC) with a differential, which will measure the number of red and white blood cells as well as platelets in the patient’s blood. If a patient is suffering from CML, their white blood cell count is increased while their red blood cell count is decreased.
- A peripheral blood smear, during which a blood sample is stained with a special dye and then examined under a microscope. This examination will show the number of blood cells as well as their type, shape, and size. This blood test allows doctors to see if and how many immature blood cells, also known as blast cells, are present in the blood sample.
Bone Marrow Aspiration and Biopsy
A bone marrow aspiration and biopsy are performed to check for any irregularities within the patient’s bone marrow. Since bone marrow consists of both liquid and solid material, during an aspiration a portion of the liquid bone marrow is removed while during a biopsy, a section of the solid part is removed.
After these samples are taken, they’re examined by a pathologist under a microscope, to see if there are any leukemia cells present.
Flow cytometry is a technique medical professionals use to get a better understanding of leukemia cells known as blasts. During the process, fluorescent labels are used and the patient’s cells are exposed to a special laser that causes them to give off light.
Afterward, a computer is used to analyze the measured light, and this gives doctors an insight into the characteristics of the patient’s particles or cells.
While leukemia is a cancer of the blood, it can still spread to other parts of the body, and doctors can check whether this has happened by performing an imaging test. There are a couple of different tests that can be done:
- Computed Tomography (CT) Scan: A CT creates 3D cross-sectional images of the patient’s body with the use of X-rays. CT scans are typically used to check whether the patient has an enlarged liver or spleen, or even enlarged lymph nodes.
- Magnetic Resonance Imaging (MRI): An MRI is an imaging test that creates cross-sectional images of the patient’s bones, blood vessels, organs, and tissues with the use of magnetic rays.
- Ultrasound: An ultrasound creates images of the body’s structure with the use of high-frequency sound waves. This imaging test is used to check whether the CML has spread to the brain, kidney, spleen or liver.
Pediatric CML Treatment
If a child is diagnosed with CML, the most important thing to do is to take them to a doctor who will be able to decide what treatment they will receive. There are three different treatment options available for pediatric chronic myeloid leukemia.
Chemotherapy is a cancer treatment option that involves the use of specialized drugs that are administered intravenously or in pill form. The point of chemotherapy is to destroy cancerous cells, slow down their growth or alleviate the symptoms the leukemia if it’s in a more advanced phase.
Chemotherapy is given in cycles and the duration of the treatment well as what drugs are administered will differ from one case to another. However, chemotherapy is rarely given as a sole treatment for CML. It’s sometimes combined with targeted therapy and other times it’s given in preparation for a bone marrow transplant.
Targeted therapy is a treatment option that uses drugs that only target the cancerous cells. While other treatment options have an effect on both the healthy and cancerous cells, targeted therapy doesn’t harm healthy cells.
For CML, targeted therapy involves the use of tyrosine kinase inhibitors (TKIs), which are designed to target the genetic abnormalities that cause CML.
Bone Marrow Transplant
If chemotherapy and targeted therapy aren’t effective enough to cure the patient, or they have a more advanced form of chronic myeloid leukemia, the doctors will perform a bone marrow transplant.
During a bone marrow transplant, unhealthy immature cells are replaced with healthy ones, and this helps the body create healthy blood cells again, making it easier to fight off the cancer.
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Sheba Medical Center provides innovative, personalized medical care to patients from around the world. We are the largest, most comprehensive hospital in the Middle East and are dedicated to providing advanced and compassionate medicine for everyone. We welcome all cases, including the rarest and the most challenging. Our medical teams collaborate to provide the best possible health outcomes. From your initial inquiry through the long-term follow-up care, we are here for you.
Request a consultation
Sheba Medical Center provides innovative, personalized medical care to patients from around the world. We are the largest, most comprehensive hospital in the Middle East and dedicated to providing advanced and compassionate medicine for everyone. We welcome all cases, including the rarest and the most challenging. Our medical teams collaborate to provide the best possible health outcomes. From your initial inquiry through the long-term follow-up care, we are here for you.
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