Stages of Chronic Myelogenous Leukemia

If you learn that you have chronic myelogenous leukemia (CML), you'll want to talk to your doctor about the stage of your cancer. It will help you and your health care team figure out the best way to treat the disease.

You may sometimes hear your doctor call chronic myelogenous leukemia by another name: chronic myeloid leukemia. It's the same disease -- a type of cancer that starts inside your bone marrow, the soft center of bones where blood cells are made.

For CML, unlike other cancers, doctors use the word "phase" instead of "stage" to describe how advanced the disease has become. There are three phases:

  • Chronic
  • Accelerated
  • Blast

To figure out the phase, your doctor takes a blood and bone marrow sample and counts the number of "blast" cells -- immature cells that grow into white blood cells. The more blast cells you have, the later the phase.

Chronic Phase

Most people first find out they have CML when they are in the chronic phase. If you're in this phase, you likely learned about your cancer after your doctor had you take a blood test for another reason.

You may have symptoms like:

  • Tiredness or shortness of breath throughout the day
  • Fever
  • Night sweats
  • Weight loss
  • Swelling in your belly
  • Feeling full quickly when you eat
  • Itching
  • Bone pain
  • Bleeding

When you're in the chronic phase, your doctor may treat you with a type of anti-cancer drug called a tyrosine kinase inhibitor. It's a pill that you take at home once a day. You may to need to take this drug for the rest of your life.

The goal of treatment is to improve your symptoms, get rid of the cancer cells, and make it less likely you will move into the next phase of CML.

If a tyrosine kinase inhibitor doesn't get rid of the cancer cells, you may need to have a stem cell transplant. Stem cells are in the news a lot, but usually when you hear about them they're referring to "embryo" stem cells that are used in cloning. The stem cells in a stem cell transplant are different. These are stem cells that live in your bone marrow and help make new blood cells.

If you need a stem cell transplant for your CML, you'll have a type called an allogenic stem cell transplant, which means the stem cells are from a person whose bone marrow matches yours.

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Accelerated Phase

Some people first find out they have CML when they are in the accelerated phase. Others find out when their chronic CML becomes worse.

If you are in the accelerated phase, you may have some of the same symptoms you had in the chronic phase.

If you just learned that you have CML, you will be treated with a tyrosine kinase inhibitor. If you are already on a tyrosine kinase inhibitor for chronic phase CML, your doctor will have you take a different one. There are five tyrosine kinase inhibitors now used to treat CML.

Just like with the chronic phase, the goal of treatment is to get rid of or curb your symptoms and try to lower your chances of moving into the next phase. Your doctor may also recommend a stem cell transplant if your medicine isn't helping enough. You may need chemotherapy so that you're in remission (no signs of cancer) before you get a transplant.

Blast Phase

The blast phase is also called the blast crisis phase. You may feel tired all the time and be short of breath. You may not want to eat very much and lose weight. You may also have a:

  • Fever
  • Infection
  • Bone pain
  • Pain in your belly
  • Large spleen

Your doctor may suggest that you start on a different tyrosine kinase inhibitor. You may also need to start chemotherapy. Another option may be an allogenic stem cell transplant.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on July 01, 2019

Sources

SOURCES:

Leukemia and Lymphoma Society: "CML Phases."

American Cancer Society: "Treating Chronic Myeloid Leukemia by Phase," "What Is Chronic Myeloid Leukemia?" "Targeted Therapies for Chronic Myeloid Leukemia."

American Society of Clinical Oncology: "Leukemia -- Chronic Myeloid -- CML: Phases," "Leukemia -- Chronic Myeloid -- CML: Symptoms and Signs."

Merck Manual: "Basophilic Disorders."

National Cancer Institute: "Philadelphia chromosome."

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