Chronic Myeloid Leukemia - Why Does It Happen?

Chronic myeloid leukemia (CML) is a cancer of the white blood cells. It is characterized by an increased and unregulated growth of myeloid cells in the bone marrow and the accumulation of these cells in the blood.

Epidemiology, Incidence, Prevalence

In Western countries, CML accounts for 15–25% of all adult leukemias and 14% of leukemias overall (including the pediatric population, where CML is less common).

Why Does It Happen?

Neither you get it from your parents or infections, nor your smoking habits and diet seem to raise any chance of getting it. The only risk is if you've been in contact with high levels of radiation. Higher incidence of CML was seen in Hiroshima and Nagasaki nuclear bombing survivors. The rate of CML in these individuals seems to peak about 10 years after the exposure.

How would you know about it?

• CML has three phases: Chronic, Accelerated, and Blastic
• Chronic- It is the earliest stage. You might not even have symptoms.
• Accelerated- The number of blood cells that don't work right increases Symptoms are as follows
• Night sweats due to hypermetabolism
• Dyspnea
• Decreased appetite
• Left upper quadrant abdominal pain from spleen infarction
• Pain in your bones
• Stroke
• Changes in your vision
• Ringing in your ear
• Fatigue, weight loss
• Loss of energy
• Decreased exercise tolerance
• Bruise

Blastic - The cells multiply and take over the healthy blood cells and platelets.

Symptoms

1. Thrombocytopenia
2. Basophilia
3. Anemia
4. Rapidly enlarging spleen in blast crisis
5. Skin changes including bumps, tumors
6. Swollen gland
7. Infections
8. Bleeding, petechiae, and ecchymosis
9. Bone pain
10. Fever
11. Investigations

Complete blood count - To see how many white blood cells, red blood cells, and platelets you have.

1. FISH test (fluorescence in situ hybridization)- It is a detailed lab test of your genes to see for Philadelphia (Ph) chromosome in bone marrow cells.
2. Polymerase chain reaction test- It is a lab test that looks for the BCR-ABL gene, which is involved in the process that tells your body to make too many of the wrong kind of white blood cells.

Ultrasonography - to see for splenomegaly

Bone marrow test. It helps you figure out how advanced your cancer is. The doctor uses a needle to take a sample, usually from your hip bone.

Treatment

1. The goal of your treatment is to destroy the leukemia blood cells in your body and restore healthy ones to a normal level. It's usually not possible to get rid of all the bad cells.
2. If you get treatment during the early, chronic phase of CML, it can help prevent the disease from moving to a more serious level.
3. Doctors usually give drugs known as tyrosine kinase inhibitors (TKIs) first. They slow down the rate at which your body makes leukemia cells.