About

Pediatric Chronic Myeloid Leukemia (CML)


About Pediatric CML (Chronic Myeloid Leukemia)

CML is much more common in adults, accounting for only 1% of all cases of childhood leukemia. This type of cancer can develop over a span of months or even years.


Chronic myeloid leukemia is a type of cancer that originates in the blood-forming cells of the bone marrow. It is caused by a chromosomal problem in which a specific type of chromosome rearrangement alters the position and function of particular genes. The result is the uncontrolled growth of white blood cells (myeloblasts). Typically, CML is a slow growing disease, although this disease can later transform into a fast growing acute leukemia.

Chronic myeloid leukemia in children does not run in families, and the risk does not appear to be affected by nutrition, chemicals, infection, or smoking.

Only a few risk factors have been proven to be associated with CML:

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

As a disease of the bone marrow, CML does not form tumors, so it can’t be staged like most types of cancer. Rather, CML is categorized based on the three general phases of the disease. These phases are defined based on the amount of immature white blood cells, called blasts, in the bone marrow or blood. According to definitions established by the World Health Organization, the three phases of CML are as follows:

  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 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 most common signs of chronic myeloid leukemia in children include:

  • Anemia: This condition occurs when a healthy amount of normal red blood cells cannot be produced because the bone marrow is overcrowded by leukemia cells. A blood test will reveal low hemoglobin levels. Children with anemia may feel very tired, appear pale, and experience a racing heart rate.
  • Swollen lymph nodes: Leukemia cells often collect in the lymph nodes, causing swelling under the arms, in the neck, in the chest and groin.
  • Bleeding and/or bruising: Bleeding can result from a very low level of platelets, which are cells that help the body form blood clots. This happens because the bone marrow cannot produce a sufficient number of platelets.
  • Bone and joint pain: When the bone marrow becomes overcrowded with blasts, pain in the bones and joints may occur.
  • Recurrent infections and/or fever: Although a child with CML may have a very high number of white blood cells, these cells cannot function properly to fight infection.
  • Consequently, it may be difficult for the child to recover from ordinary childhood infections.
  • Trouble breathing: Leukemia cells may clump together in the thymus gland, located beneath the sternum and around the throat. This clump of cells can affect breathing, making children wheeze, cough, or experience painful breathing.
  • Abdominal pain: When leukemia cells accumulate in the liver, kidneys, and spleen, they can cause these organs to enlarge, leading to abdominal pain.

What is CML?

Chronic myeloid leukemia is a type of cancer that originates in the blood-forming cells of the bone marrow. It is caused by a chromosomal problem in which a specific type of chromosome rearrangement alters the position and function of particular genes. The result is the uncontrolled growth of white blood cells (myeloblasts). Typically, CML is a slow growing disease, although this disease can later transform into a fast growing acute leukemia.

 

What are the Risk Factors for CML?

Chronic myeloid leukemia in children does not run in families, and the risk does not appear to be affected by nutrition, chemicals, infection, or smoking.

Only a few risk factors have been proven to be associated with CML:

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

 

What are the Phases of CML?

As a disease of the bone marrow, CML does not form tumors, so it can’t be staged like most types of cancer. Rather, CML is categorized based on the three general phases of the disease. These phases are defined based on the amount of immature white blood cells, called blasts, in the bone marrow or blood. According to definitions established by the World Health Organization, the three phases of CML are as follows:

  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 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 in children?

The most common signs of chronic myeloid leukemia in children include:

  • Anemia: This condition occurs when a healthy amount of normal red blood cells cannot be produced because the bone marrow is overcrowded by leukemia cells. A blood test will reveal low hemoglobin levels. Children with anemia may feel very tired, appear pale, and experience a racing heart rate.
  • Swollen lymph nodes: Leukemia cells often collect in the lymph nodes, causing swelling under the arms, in the neck, in the chest and groin.
  • Bleeding and/or bruising: Bleeding can result from a very low level of platelets, which are cells that help the body form blood clots. This happens because the bone marrow cannot produce a sufficient number of platelets.
  • Bone and joint pain: When the bone marrow becomes overcrowded with blasts, pain in the bones and joints may occur.
  • Recurrent infections and/or fever: Although a child with CML may have a very high number of white blood cells, these cells cannot function properly to fight infection. Consequently, it may be difficult for the child to recover from ordinary childhood infections.
  • Trouble breathing: Leukemia cells may clump together in the thymus gland, located beneath the sternum and around the throat. This clump of cells can affect breathing, making children wheeze, cough, or experience painful breathing.
  • Abdominal pain: When leukemia cells accumulate in the liver, kidneys, and spleen, they can cause these organs to enlarge, leading to abdominal pain.

 

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