Chronic Myelogenous Leukemia

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KEY POINTS

• Chronic myelogenous leukemia is a cancer of the blood and bone marrow.
• Chronic myelogenous leukemia is usually treated with medicines. If other treatments aren’t working, a stem cell transplant may be a possible treatment.
• You will need to have regular blood tests and follow-up visits with your healthcare provider.

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What is chronic myelogenous leukemia?

Chronic myelogenous leukemia (CML) is a cancer of the blood and bone marrow. It affects bone marrow stem cells that produce white blood cells. The cancer causes large numbers of abnormal white cells called myelocytes to form in the bone marrow. These abnormal cells crowd out normal blood cells in the bone marrow and move through the bloodstream.

Other names for this type of leukemia are chronic myeloid leukemia and chronic granulocytic leukemia.

The sooner cancer is found and treated, the better your chances for recovery. However, even advanced cancer can usually be treated. Treatment may slow or stop the growth of the cancer and ease symptoms. Ask your healthcare provider what you can expect with the type of cancer that you have.

What is the cause?

The cancer starts in the bone marrow. Marrow is the soft, fatty tissue inside hard bone. The marrow is where blood cells are formed.

• White blood cells help fight off infection.
• Red blood cells carry oxygen and nutrients to your body.
• Platelets help your blood clot.

Chronic myelogenous leukemia happens when your body makes too many abnormal white blood cells. The abnormal cells crowd out other, normal blood cells needed by your body.

• The abnormal white cells cannot fight infections.
• Fewer red blood cells make you tired and weak.
• Fewer platelets cause you to bleed easily.

The cancer can also spread to other parts of your body.

Most people who have CML have an abnormal chromosome called the Philadelphia chromosome. This abnormal chromosome makes a gene called BCR-ABL, which causes abnormal white blood cells to grow out of control.

Usually it is not known why this chromosome change happens, but it is not inherited from your parents. Your risk of CML is greater if:

• You are middle aged or older.
• You have been exposed to a very high dose of radiation, like from an atomic bomb blast.

What are the symptoms?

CML may have no symptoms or just mild symptoms at first. The symptoms slowly get worse. They may include:

• Feeling very tired
• Unexpected weight loss
• Fever or night sweats
• A sense of fullness or pain below the ribs on the left side, caused by an enlarged spleen
• Feeling full after eating less than a full meal

How is it diagnosed?

Your healthcare provider may discover the disease during a routine blood test. Or your provider may find that you have an enlarged spleen during a physical exam. You may have a bone marrow biopsy, which uses a needle passed through the skin to take a small sample of tissue for testing, usually from the back pelvic bone.

How is it treated?

CML can be treated with medicines that block the protein tyrosine kinase and stops the abnormal stem cells from developing white cells. This medicine can be effective for years, but it may not cure the disease.

You will need to take medicine regularly to keep your white blood cell count normal, or you may need medicine only part of the time. Your healthcare provider will watch your condition and your blood cell count closely. You will have blood tests to make sure the medicine is working.

If other treatments aren’t working, a stem cell transplant may be a possible treatment, using your own cells or cells from a donor.

With treatment, many people with CML have no symptoms from the disease. The time when symptoms go away is called a remission.

How can I take care of myself?

If you have been diagnosed with CML:

• Talk about your cancer and treatment options with your healthcare provider. Make sure you understand your choices.
• Follow the full course of treatment prescribed by your healthcare provider.
• Ask your healthcare provider:
  • How and when you will get your test results
  • How long it will take to recover
  • If there are activities you should avoid and when you can return to your normal activities
  • How to take care of yourself at home
  • What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

Other things that may help include:

• Eat a healthy diet and get regular exercise as recommended by your healthcare provider.
• Get plenty of rest.
• Try to reduce stress and take time for activities that you enjoy. Talk with your family and your healthcare providers about your concerns. Ask your healthcare provider any questions you have about the disease, treatments, side effects of the treatments, sexual activity, support groups, and anything else that concerns you.
• If you smoke, try to quit.
• Ask your provider if you need to avoid drinking alcohol. It may interfere with medicines you are taking. Alcohol can also make it harder for white blood cells to fight infections.
• Tell your provider if your treatment causes discomfort. Usually there are ways to help you be more comfortable.

For more information, contact:

• Leukemia and Lymphoma Society
  800-955-4572
  http://www.lls.org/