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Chronic myelogenous leukemia (CML)
CML; Chronic granulocytic leukemia; Leukemia - chronic granulocytic (CML)Overview
Chronic myelogenous leukemia is
Review Date: 3/2/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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CML most often occurs in middle-aged adults and in children. The disease affects 1 to 2 people per 100,000 and makes up 7 - 20% cases of leukemia.
It is usually associated with a chromosome abnormality called the Philadelphia chromosome.
Radiation increases the risk of developing CML. Exposure may occur from:
It takes many years to develop leukemia from this cause. However, most people treated for cancer with radiation do not go on to develop leukemia, and most patients with CML have not been exposed to radiation.
CML causes rapid growth of the immature blood-forming cells (myeloid precursors) in the bone marrow, blood, and body tissues.
Chronic myelogenous leukemia is grouped into several phases:
The chronic phase can last for months or years. The disease may have few or no symptoms during this time. Most people are diagnosed during this stage, when they are having blood tests done for other reasons.
The accelerated phase is a more dangerous phase, during which the leukemia cells grow more quickly. This phase may be associated with
If untreated, CML progresses to the blast crisis phase. Bleeding and infection may occur due to bone marrow failure. Other possible symptoms include:
Call your health care provider if you have symptoms of CML or have been diagnosed with CML and develop a fever higher than 100°F, chills, sore throat, or cough.
Imatinib (Gleevec) is the first-line therapy for everyone with CML. Gleevec is a pill, taken by mouth. It is associated with very high rates of remission and survival. New medications similiar to Gleevec include dasatinib (Sprycel) and nilotinib (Tasigna).
Sometimes a chemotherapy medicine called hydroxyurea (Hydrea) is used temporarily to reduce the white blood cell count if it is very high at diagnosis.
The blast crisis phase is very difficult to treat, because it is marked by a very high count of immature white blood cells (leukemia cells). It is treated similarly to acute myeloid leukemia (AML) or acute lymphoid leukemia (ALL).
The only known cure for CML is a
Avoid exposure to radiation when possible.
Since the introduction of Gleevec, the outlook for patients with CML has improved dramatically. When the signs and symptoms of CML go away, you are said to be in remission. Many patients can remain in remission for many years while on this drug.
Stem cell tansplantation should be considered in patients whose disease comes back after initial treatment with imatinib (Gleevec). Long-term cure after transplantation ranges from 60 - 80%.
Blast crisis can lead to complications, including infection, bleeding, fatigue, unexplained fever, and kidney problems. Chemotherapy can have serious side effects, depending on the drugs used.
A physical examination often reveals a swollen spleen. A complete blood count (CBC) shows an increased number of white blood cells.
Other tests that may be done include:
This disease may also alter the results of the following tests: