Chronic Myelogenous Leukemia, also known as Chronic Myeloid Leukemia and Chronic Granulocytic Leukemia, is a cancer of the white blood cells. It is characterized by the unregulated growth of myeloid cells in the bone marrow and in the blood. Usually starts as chronic form and can change into acute leukemia -blast crisis.
Chromosomal translocation t(9;22) Philadelphia chromosome is seen in 90% of patient with CML, its abnormal gene that causes the abundance of diseased blood cells.
Risk factors for CML
Factors that increase the risk of Chronic Myelogenous Leukemia:
- Gender: Males are more affected
- Radiation exposure: Such as radiation therapy for certain types of cancer
Phases of Chronic Myelogenous Leukemia
The phase of Chronic Myelogenous Leukemia refers to the aggressiveness of the disease. Phases of CML include:
- Chronic Phase: The chronic phase is the earliest phase and generally shows the best response to treatment. It is asymptomatic initially.
- Accelerated Phase: The accelerated phase is a transitional phase when the disease becomes more aggressive. There is more rapid production of defective cells, may present as petechia, ecchymosis or fever.
- Blastic Phase: Blastic phase is a severe, aggressive phase that can become fatal. There is a rapid immature cell production and significant bone pain increase in myeloblasts.
Signs and Symptoms of Chronic Myelogenous Leukemia
Asymptomatic at time of diagnosis, there are no obvious signs and symptoms during the early phase, later they may include:
- Recurrent infection
- Easy bruising
- Fatigue and easy tiredness
- Low-grade fever
- Weight loss
- Loss of appetite
- Splenomegaly and hepatomegaly
- Night sweats
Diagnostic Tests for Chronic Myelogenous Leukemia
- Physical examination: The consultant will on examination check lymph nodes, spleen and abdomen for abnormalities.
- Blood tests: A complete blood count may reveal abnormalities in your blood cells, leucocytosis increase in WBC count between 50-200 thousand. Leukocyte alkaline phosphatase stains are very low to absent in most cells
- Bone Marrow tests: Bone Marrow Biopsy and bone marrow aspiration are used to collect bone marrow samples for laboratory testing. The pathologist studies the type and number of blood-forming cells in the bone marrow aspirate and biopsy, also examines the size and shape of the cells. There is an increase in the number of myeloblasts.
- Tests to look for the Philadelphia Chromosome: Specialized tests, such as Fluorescence In Situ Hybridization (FISH) analysis, for the presence of the Philadelphia chromosome.
Treatment of CML
In most cases, the cure is not possible, but treatment can help achieve a long-term remission. Treatment is based on the phase of the disease, as well as the patient’s age and general health. Treatment for CML may include:
- Targeted drugs: Targeted drugs are the initial treatment for most people diagnosed with Chronic Myelogenous Leukemia. These drugs focus on a specific aspect of cancer cells that allows them to grow and multiply. Most people continue to take targeted drugs even in remission of Chronic Myelogenous Leukemia.
- Allogenic Stem Cell Transplant: Allogenic Stem Cell Transplant is the only chance to cure Chronic Myelogenous Leukemia. During stem cell transplant, high doses of chemotherapy drugs are given to destroy the blood-forming cells in bone marrow. Then, blood stem cells from a donor are infused into the bloodstream. The new cells form new, healthy blood cells to replace the diseased cells.
- Chemotherapy: Usually chemotherapy in CML is given in combination with another mode of treatment chemotherapy treatment for Chronic Myelogenous Leukemia is given as a tablet to be taken by mouth. Side effects of chemotherapy drugs depend on what drugs you take.
- Biological therapy: Biological therapies to help body’s immune system to help fight cancer. Interferon helps reduce the growth of leukemia cells. Interferon may be an option if other treatments don't work.
- Regular follow-up is very important. Blood tests and imaging tests on the regular basis are important.
- Medications can cause many side effects, but those side effects often can be managed with other medications or treatments.
- It’s important not to stop treatment on own, otherwise, the disease can quickly return, even if you've been in remission.
Factors affecting the Cost of Treatment of CML
The cost to the patient depends on a variety of factors like:
- The hospital patient chooses
- Fees for the team of doctors
- Medicine cost
- Cost of Tests and diagnostic procedure
- Type of treatment: Cost of stem cell transplant, cost of targeted drug therapy, cost of chemotherapy
- Cost of follow-up care required.