Chronic myelogenous leukemia (called CML or sometimes chronic myeloid leukemia) is a cancer that affects blood cells and bone marrow, where blood cells are made.
Your body makes too many abnormal white blood cells. These don’t work like healthy white blood cells to help fight infection.
CML has three phases: chronic, accelerated, and blastic.
Chronic-phase CML is the earliest phase and the easiest to treat. You might not even have symptoms.
In the accelerated phase, the number of abnormal blood cells increases. You’re likely to have some of these symptoms:
- Night sweats
- Shortness of breath
- Unexplained weight loss
- Appetite loss
- Swelling or pain on your left side (which could be a sign of an enlarged spleen)
- Bone pain
Other side effects may include stroke, visual changes, ringing in the ears, stupor, and prolonged erections.
In the blastic phase, the most serious CML phase, the abnormal cells multiply and crowd out healthy blood cells and platelets (which help stop bleeding). You’ll have more severe symptoms, including infections, bleeding, skin lesions, swollen glands, and bone pain.
What Causes CML?
CML starts in your DNA. Sections of two different chromosomes (9 and 22) switch places and produce a new one, called the Philadelphia chromosome. It creates a new gene product called BCR-ABL, which tells blood cells to make a protein called the BCR-ABL tyrosine kinase.
This protein tells your body to begin making too many abnormal, or immature, white blood cells, leaving less room for healthy blood cells and platelets.
Your CML Diagnosis
You may not have any symptoms. Your doctor may discover CML during a routine blood test.
Several tests can confirm the diagnosis:
- A complete blood count to determine how many white blood cells, red blood cells, and platelets you have
- Bone marrow tests to determine how advanced the cancer is
- Fluorescence in situ hybridization (FISH) to measure the number of cells containing the Philadelphia chromosome
- CT scans to evaluate the size of your spleen
- Polymerase chain reaction to look for the BCR-ABL gene.
What Happens Next?
Once you're diagnosed, you should see a hematologist-oncologist, a doctor with special training in blood diseases, especially cancer. This doctor will come up with a treatment plan for you. Your goal is to stay in the chronic CML phase and remain symptom-free.
Learn as much as possible about your condition. You'll feel better prepared to manage your CML once you understand it better.
Ask questions freely. Ask about your treatment options, what results you can expect, what side effects you might have -- and whether you need a second opinion. Bring a list of questions to your doctor appointments.
The goal is to destroy the abnormal blood cells in your body and restore healthy blood cells to a normal level.
Getting treatment during the early, chronic phase of CML can prevent the disease from moving to a more serious level. Once you are treated, you should be able to resume a normal life.
Drugs known as tyrosine kinase inhibitors (TKIs) are usually the first given. They slow down the production of abnormal white cells. TKIs commonly used include: imatinib (Gleevec), dasatinib (Sprycel), and nilotinib (Tasigna).
Bosutinib (Bosulif) and ponatinib (Iclusig) may be used if other drugs don't help or if you can’t tolerate their side effects.
Synribo (omacetaxine mepesuccinate) is for people whose disease progresses after they have used two or more TKIs.
Other CML treatment options include chemotherapy or biologic therapy with interferon. A stem cell transplant, which requires a matching donor, is an option when other treatments don't work.