bone cancer

An Overview of Chronic Myeloid Leukemia (CML)

Dr. Indoo Ambulkar
20 Oct 2018
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Chronic Myeloid Leukemia (CML) is a type of cancer that originates in blood and spreads to the cells of bone marrow. The symptoms can be bone pain, problems while eating, enlarged spleen and pain in belly. Its treatment includes stem cell transplant, radiation therapy, chemotherapy and targeted therapy.

Chronic Myeloid Leukemia (CML) is a type of cancer that originates in blood and infects the cells of the bone marrow (soft tissue in the center of most bones). This cancer occurs because of genetic defects which impact bone marrow cells whose unique function is to produce red blood cells, platelets, and most types of white blood cells (except lymphocytes).

This genetic change is responsible for the formation of an abnormal gene known as BCR-ABL, which changes a normal cell into Chronic Myeloid leukemia (CML) cancer cell that mainly affects blood cells.

The CML cells grow and divide normally at a slow pace and rarely these are found at a fast growing speed, which may not be curable in all cases.

As CML cells replace normal cells, it spreads in the bone marrow and spill over into the blood thereby affecting the whole body. Moreover, after entering into the bloodstream, it induces the number of white blood cells to increase within the blood. The blood streams are the medium through which CML cells get into other organs of the body thereby impairing the organs and their functions.

Leukemia cell is an immature version of a normal cell, which does not die itself as in case of a healthy body; rather it divides to make new cells and pushes out normal cells. 

Age Group Prone to Get CML

Generally, adults suffer from this deadly condition and it rarely occurs in children, though, the treatment processes are the same in both cases. CML can occur at any age but it is more common in adults over the age of 40, who account for nearly 70% of all cases.

Signs and Symptoms of Chronic Myeloid leukemia

Though symptoms are unclear yet the following can be the symptoms of CML and may also be related to other types of cancers:

  • Bone pain is caused by leukemia cells spreading from the marrow cavity to the surface of the bone
  • Enlarged spleen can be felt under the left side of the ribcage
  • Unable to eat properly and feeling full with small diet.
  • Fever, weakness, weight loss, fatigue and night sweat are a few common signs.
  • Pain in belly

Other Problems Faced By CML Patients are:

  • Shortage of active white blood cells (Leukopenia): This increases the risk of infection as white blood cells may be high in count but are not active to fight against infections.
  • Shortage of red blood cells (Anemia): This can contribute to tiredness, weakness, and shortness of breath.
  • Shortage of blood platelets (Thrombocytopenia): Patient may experience serious nose bleeding or bleeding gums or bruising. In this case, patients have too many platelets but do not work as they tend to as per normal human body.
  • Neutrophils are lower than normal count (Neutropenia): White blood cells, Neutrophils are capable of fighting against bacteria. In this stage, there is a high risk of getting bacterial infections.

Types Of Leukemia

It’s essential for doctors to understand any specific type of leukemia with respect to a particular patient. Only then, the best treatment option can be opt out. Further, types of leukemia are elaborated:

  • Chronic leukemia: In this type of leukemia, cells do not reach maturity even though they may look like other normal mature cells. People, who have such condition, are unable to fight with normal disease and infections. Compared to a normal cell, any leukemia cell has long life. There is high probability that people in this condition can live for many years as it takes a long time before it causes problems that are apparently visible. Still, chronic leukemia has been categorized as ‘hard to cure’.
  • Myeloid leukemia: This condition starts within immature myeloid cells. The cells that can turn into white blood cells, red blood cells or platelet itself.
  • Lymphocytic leukemia: This type of leukemia occurs within the cells itself which become lymphocytes (a form of white blood cell) later. In such condition, cancer exists in the bone marrow and blood.

Other Types of leukemia

There are 3 other types and names assigned to various types of leukemia as per their characters and whether they are chronic or acute and myeloid or lymphocytic:

  • Acute Myeloid leukemia
  • Acute Lymphocytic leukemia
  • Chronic Lymphocytic leukemia 

Diagnosis

There are chances that chronic leukemia may get caught in any routine blood test as it takes time before symptoms can be seen in the daily life of a person.

1. Physical exam

Unlike laboratory test, doctors look for any physical signs such as pale skin from anemia, swelling of lymph nodes, and enlargement of liver and spleen.

2. Blood tests

In this method, blood samples are sent to laboratories for testing to acknowledge if, there is any abnormal level of red, white blood cells or platelets.

3. Genetic test

This test is carried out to check for BCR-ABL gene for confirming CML and study of the cells. 

4. Polymerase chain reaction (PCR)

This test is extremely sensitive and helps to locate BCR-ABL gene found in leukemia cells as well as to determine their quantity. The test is performed on the blood and bone marrow cells. It makes it easy to detect even very small amounts of BCR-ABL gene even if it is not detected on a cytogenetic test. Not just this, it also helps to find out about the copies of the genes once the treatment is completed as the presence of copies indicates the presence of cancer.

5. Conventional cytogenetics

This test has karyotype as the main procedure, which involves chromosomal study for any possible changes caused to the cell structure. It is a time-consuming process because cells from bone marrow or blood are grown in a lab for further analysis and also not guaranteed to always work.

6. Bone marrow test

Removing a sample of bone marrow from hipbone for which a long, thin needle is used generally does this test. Thereafter, samples are sent to a laboratory to assess whether it has leukemia cells in it or not.

7. Fluorescent in situ hybridization (FISH)

This test also includes the analysis of chromosomes. Special fluorescent dyes are put to use that attaches to certain genes and chromosomal parts. This test is utilized to view the BCR-ABL gene on chromosomes. It is beneficial in a way that it doesn’t require blood or bone marrow cells to be grown first and provide results faster than the conventional cytogenesis. 

8. Imaging

Imaging lets the doctors have a look inside the body. It may not actually detect cancer but can tell about the reason for symptoms and the enlarged organs like liver and spleen.

9. Computed Tomography (CT) Scan

CT scan is useful in seeing the enlarged lymph nodes or other organs in the body precisely to check the presence of CML. At times, a biopsy needle guided by the imaging technology is inserted into the possible cancerous growth to get a sample that is further analyzed under a microscope in the lab but this is not a common way of testing. 

10. Ultrasound and Magnetic Resonance Imaging (MRI)

These are other important scanning techniques that give a clear picture of the internal organs like liver, spleen, spinal cord and brain to determine the growth and presence of the CML.

Treatment Options

After determining certain characteristics of leukemia, a specific treatment option can choose. Certain factors are taken into consideration before going for any specific treatment such as:
Age, health condition, type of leukemia, which part of the body is affected or whether leukemia has reached nervous system or not?

Following are Types of Therapies Used to Treat Chronic Myeloid Leukemia:

1. Radiation therapy

In order to damage and stop leukemia cells from growing, radiation therapy is used. In this therapy, a large machine is used to direct the radiation on some specific body parts. X rays and high-energy beams are helpful in the process.

2. Stem cell transplant

It is quite alike bone marrow transplant. Before a patient undergoes this transplant, high doses of chemotherapy are given to destroy the affected bone marrow. Only thereafter, the insertion of new stem cells is possible. Under this process, the diseased bone marrow is replaced with healthy bone marrow. For which a donor is required and in other cases, patient own bone marrow can also be used.

3. Targeted therapy

In this therapy, firstly, vulnerabilities within cancer cells are identified in order to attack upon. There are certain drugs, which can make a protein, within leukemia cells non-functional.

4. Biological therapy

Leukemia is well treated with the help of immune system, which plays the main role to acknowledge and attack leukemia cells.

5. Chemotherapy

Via chemotherapy, chemicals are infused with the help of drugs or injections. Drugs can be single or in a combination. 

Leukemia is not easy to diagnose, as the symptoms are very basic and difficult to recognize in most cases. Therefore, without the proper diagnosis and medical intervention, timely detection becomes challenging. More early it is diagnosed, less time it will take to recover. You can also contact +91-8929020600 for information on Chronic Myeloid Leukemia (CML) or other cancers.


Dr. Indoo Ambulkar

About the Author

Medical Oncologist
Dr. Indoo Ambulkar is a Medical Oncologist practicing at SevenHills Hospital in Andheri East, Mumbai. Dr. Indoo specializes in the treatment of Breast Cancer, Esophageal cancer, Lung cancer, Lymphomas, Co-rectal cancer, Brain Tumor, Colorectal Surgery, Lung Cancer, Head and Neck Surgeries. She has completed her MBBS from Tata Institute Of Medical Science in the year 2001. Further, she pursued DM in Oncology from Holy Spirit Hospital in the year 2003. Dr. Indoo Ambulkar has an experience of more than one and a half decades in the field of oncology treatments. Dr. Indoo is also a practices at SevenHills Hospital, a super specialty center at Andheri East, Mumbai. Seven Hills Hospital is serving patients in different fields of medicine since 1986. The hospital offers various facilities such as healthcare packages, inpatient services, diagnostic services, insurances as well as patients voice. Book a FREE appointment with Dr. Indoo Ambulkar at Elacancer.com.
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