Chronic Myeloid Leukemia, or CML, is a type of cancer that causes a genetic change in myeloid cells, which are responsible for producing red blood cells, platelets and some white blood cells.
This type of leukemia is caused by a genetic change in the bone marrow, which causes the abnormal growth and division of blood cells, which can cause symptoms such as fatigue, weight loss, bleeding and bone pain.
The treatment of Chronic Myeloid Leukemia must be carried out by an oncologist or hematologist and includes chemotherapy, radiotherapy, immunotherapy or bone marrow transplant, for example.
Main symptoms
The main symptoms of Chronic Myeloid Leukemia are:
- Easy and frequent bleeding;
- Fatigue and malaise;
- Fever;
- Weight loss without apparent cause;
- Bone pain;
- Pain below the ribs, on the left side of the belly;
- Pallor;
- Night sweats.
Symptoms of Chronic Myeloid Leukemia usually appear in more advanced stages of the disease.
Therefore, in the presence of signs and symptoms that may indicate CML, it is advisable to consult an oncologist or hematologist so that a complete clinical evaluation can be carried out and the cause of the symptoms can be identified.
Stages of Chronic Myeloid Leukemia
According to the World Health Organization, Chronic Myeloid Leukemia is classified into 3 phases, as follows:
1. Chronic phase
Most people are diagnosed at this stage and experience an increase in the number of white blood cells in their blood. People in this stage have no symptoms or may have mild symptoms. However, if left untreated, the chronic phase can evolve into the accelerated phase.
2. Accelerated phase
People are considered to be in an accelerated phase if any of the following conditions are present:
- High white blood cell count;
- Basophils make up 20% or more of the blood;
- Very low or very high platelet counts;
- New changes in CML cells.
People with accelerated phase CML often experience symptoms such as fever, fatigue, lack of appetite and weight loss. When left untreated, this phase can progress to the blastic phase.
3. Blastic phase
In the blast phase, which is also called blast crisis, the person has a very high white blood cell count and changes in platelets. This stage is when leukemia transforms into acute myeloid leukemia. People at this stage usually experience symptoms such as fever, bone pain, lack of appetite, bleeding and weight loss.
How the diagnosis is made
The diagnosis of Chronic Myeloid Leukemia is made by the oncologist, or hematologist, based on the evaluation of the signs and symptoms presented by the person and the physical examination, where the lymph nodes, spleen and abdomen are palpated to check for any changes.
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To confirm the diagnosis, the doctor also recommends carrying out a blood count, to check the levels of white and red blood cells in the blood, and a genetic test to identify the change in the Philadelphia chromosome or the BCR-ABL gene.
The doctor may also request a bone marrow biopsy, myelogram, cytogenetic analysis, PCR or fish test, which is an exam used to evaluate the genes and chromosomes in cells.
Possible causes
Chronic Myeloid Leukemia is a type of non-hereditary cancer, caused by a genetic alteration in the bone marrow, which generates a chromosome that is shorter than normal. This new altered chromosome is called the Philadelphia chromosome and is found in the leukemia cells of almost all people with CML.
This change in the chromosome leads to the formation of the BCR-ABL gene, which increases the production of tyrosine kinase, a protein that favors the growth and abnormal division of blood cells, resulting in cancer.
Additionally, some factors that may increase the risk of developing Chronic Myeloid Leukemia include advanced age, being male and radiation exposure.
What is the treatment like?
The treatment of Chronic Myeloid Leukemia must be carried out by an oncologist or hematologist and varies depending on the stage of the disease, age and health status of the person. CML treatment can be done with the use of medications or therapies, such as chemotherapy, immunotherapy and stem cell transplantation, for example.
1. Medicines
The oral medications generally indicated are tyrosine kinase enzyme inhibitors, such as Imatinib, Dasatinib, Nilotinib, Bosutinib or Ponatinib, which are generally the initial treatment for people with CML.
These medications have the function of blocking the activities of tyrosine kinase enzymes. As they specifically act on these enzymes, these medications generally cause fewer side effects, improving the quality of life of people with CML.
Tyrosine kinase enzyme inhibitors can be indicated for all stages of Chronic Myeloid Leukemia. However, the dosages and types of medication vary depending on each stage of the disease.
2. Chemotherapy
Chemotherapy is a treatment that eliminates or blocks the growth of cancer cells, and can be carried out using oral tablets or injectables, which are administered through a vein, intramuscularly or under the skin, for example. Understand better how chemotherapy is performed.
Generally, chemotherapy is a highly recommended treatment in the blastic phase of Chronic Myeloid Leukemia, to try to regress CML to the chronic phase. In addition, high doses of chemotherapy may also be indicated to prepare the person’s body to receive a stem cell transplant.
3. Stem cell transplant
This treatment stimulates the immune system to form specialized cells, and is done by collecting stem cells from the umbilical cord, bone marrow or blood from a healthy donor. These cells are then transplanted into the person with Chronic Myeloid Leukemia.
Stem cell transplantation can be indicated at any stage of CML, and is chosen by the doctor according to the person’s age, general health, the disease’s response to other treatments and the availability of a compatible donor.
4. Bone marrow transplant
A bone marrow transplant involves removing healthy cells from a donor’s bone marrow and then introducing them into the bloodstream of a person with CML. This treatment promotes the formation and multiplication of healthy blood cells. See how a bone marrow transplant is performed.
This treatment is generally indicated for people who do not respond to other treatments.
5. Splenectomy
Splenectomy is a surgery to remove the spleen, and is indicated when this organ increases in size and compresses other organs. However, splenectomy is only indicated in CML when treatment with chemotherapy or radiotherapy fails to reduce the size of the spleen. Understand more about splenectomy.
6. Immunotherapy
Immunotherapy is a treatment that strengthens the immune system, helping the body fight Chronic Myeloid Leukemia.
Interferon-alpha is the most commonly used drug in the immunotherapy treatment of Chronic Myeloid Leukemia. However, interferon immunotherapy is currently little used, as tyrosine kinase inhibitors are more efficient and cause fewer side effects.
7. Radiotherapy
Radiotherapy is a type of treatment that aims to destroy or prevent the growth of tumor cells, through the application of concentrated radiation directly to the tumor.
Although radiation therapy is rarely used to treat patients with Chronic Myeloid Leukemia, it may be used to shrink the spleen, help treat bone pain, or be given in low doses as part of a stem cell transplant.
Is there a cure for Chronic Myeloid Leukemia?
There is currently no cure for Chronic Myeloid Leukemia. However, currently available treatments help reduce or eliminate the symptoms of CML, allowing the person to have a good quality of life for many years.
