Chronic Myeloid Leukemia (CML)

What is Chronic Myeloid Leukemia (CML)?

Chronic myelogenous leukemia (CML) is an uncommon type of cancer that affects the bone marrow, the spongy tissue inside bones responsible for blood cell production. CML leads to an increased number of white blood cells in the bloodstream, disrupting normal blood function. This cancer typically progresses slowly, hence the term “chronic,” and predominantly affects older adults, although it can occur at any age.

Symptoms of CML

Chronic myelogenous leukemia often remains asymptomatic in its early stages, making it frequently detectable only through routine blood tests. When symptoms do manifest, they may include:

  • Bone Pain: Often resulting from the accumulation of abnormal cells in the bone marrow.
  • Bleeding Easily: Due to decreased platelet counts.
  • Early Satiety: A feeling of fullness after consuming only a small amount of food.
  • Fatigue: A common symptom stemming from anemia.
  • Fever: Indicative of an underlying health issue.
  • Unexplained Weight Loss: Occurs without intentional dieting.
  • Loss of Appetite: A general decline in interest in food.
  • Pain or Fullness Below the Ribs: Particularly on the left side, where the spleen is located.
  • Excessive Night Sweats: Often disrupting sleep.
  • Visual Disturbances: Such as blurry vision, which can be caused by bleeding in the eye.

 

Causes of CML

The exact cause of CML remains unclear, but it is linked to genetic changes in bone marrow cells. Specifically, a piece of chromosome 9 switches places with a section of chromosome 22, leading to the formation of the Philadelphia chromosome. This genetic alteration creates a new gene called BCR-ABL, which produces an excessive amount of a protein known as tyrosine kinase. This protein promotes the uncontrolled growth of specific blood cells, resulting in an overabundance of dysfunctional white blood cells that crowd out healthy cells in the bone marrow.

Risk Factors of CML

Several factors may increase the risk of developing CML:

  • Age: CML is more commonly diagnosed in older adults compared to children and adolescents.
  • Gender: Males have a slightly higher risk of developing CML than females.
  • Radiation Exposure: Previous radiation therapy for other cancers has been linked to a higher incidence of CML.

It is important to note that there is no known method to prevent CML, and family history does not play a role in the development of the disease, as the genetic changes typically occur after birth.

Diagnosis

The diagnosis of chronic myelogenous leukemia involves several tests and procedures:

  1. Physical Examination: A healthcare provider assesses vital signs and checks for signs of swelling in lymph nodes, the spleen, and the abdomen.

  2. Blood Tests: A complete blood count (CBC) measures different types of blood cells. CML often presents with a significantly elevated white blood cell count.

  3. Bone Marrow Tests: Bone marrow biopsy and aspiration are conducted to collect samples from the bone marrow for further analysis.

  4. Genetic Testing: Specialized tests, such as fluorescence in situ hybridization (FISH) and polymerase chain reaction (PCR), are used to detect the Philadelphia chromosome or the BCR-ABL gene.

Phases of CML

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CML progresses through three distinct phases, each indicating a different level of disease aggressiveness:

  1. Chronic Phase: The earliest and most treatable phase, characterized by a better response to treatment.

  2. Accelerated Phase: A transitional phase where the disease begins to become more aggressive.

  3. Blast Phase: The most severe stage, resembling acute leukemia and requiring immediate attention.

Treatment Options

The primary goal in treating CML is to eliminate blood cells containing the BCR-ABL gene. Treatment plans vary based on the disease’s phase and individual patient factors. Common treatment options include:

Targeted Th*rapy

Targeted th*rapy is the first line of treatment for CML. This approach focuses on inhibiting the activity of the tyrosine kinase protein produced by the BCR-ABL gene. While these treatments can effectively induce long-term remission, they may have side effects, including swelling, fatigue, nausea, and skin rashes. Regular blood tests help monitor the effectiveness of this th*rapy.

Bone Marrow Transplant

Bone marrow transplantation is considered a potential cure for CML but is typically reserved for cases that do not respond to other treatments. This procedure involves using high doses of chemotherapy to eliminate diseased cells before introducing healthy blood-forming cells from a compatible donor.

Chemoth*rapy

In certain situations, chemotherapy may be used in conjunction with targeted therapies to manage aggressive forms of CML. The specifics of chemotherapy regimens can vary, and side effects depend on the medications used.

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