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Leukemia: Chronic Myelogenous

Another name for this type of leukemia is chronic myeloid leukemia.

Definition

Chronic myelogenous leukemia (CML) is a rare, life-threatening cancer that starts in the bone marrow. Marrow is the soft, fatty tissue inside the bones. Blood cells are made in the bone marrow. When you have leukemia, the bone marrow makes abnormal white blood cells. Normal white blood cells help your body fight infections. Although these leukemia cells are not normal, at first they function almost normally. However, leukemia can cause the number of white blood cells in the bone marrow to be 20 to 40 times higher than normal. The leukemia cells then crowd out healthy blood cells and can affect your ability to fight infection.

Getting Diagnosed / Treatment

CML is treated at the U-M Cancer Center in the Adult Hematology Clinic.

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How does it occur?

The cause of this cancer is not known. However, often it appears to be related to an abnormal chromosome called the Philadelphia chromosome. The Philadelphia chromosome is not passed from parent to child. Exposure to very high levels of radiation is another risk factor.

CML develops mainly in people who are middle-aged and sometimes in people who are older.

What are the symptoms?

The symptoms vary a lot. Some people have no symptoms, especially in the early stages of the disease. Your health care provider may discover the disease during a routine blood test. Or during a physical exam your provider may find that you have an enlarged spleen.

When they occur, symptoms are usually mild at first and get worse gradually. They may include:

The disease has an acute phase, a chronic phase, and an accelerated phase. With frequent checkups, your health care provider will recognize a change in phases.

How is it diagnosed?

Your provider will ask about your medical history and examine you. Your provider will check for an enlarged spleen.

You will have blood tests, including:

You will have a bone marrow biopsy. In this procedure, a small sample of bone marrow is taken, usually from the posterior pelvic bone, and sent to the lab for tests. First your health care provider numbs the area over the bone and then uses a needle to get the sample. Usually this biopsy is done in your provider's office.

How is it treated?

The chronic phase of CML is often controlled by medicine to keep the white blood cell count normal. The medicines most commonly used at the beginning of treatment are hydroxyurea and imatinib. Others used later are busulfan and interferon. With treatment, most people have no symptoms from the disease. You may need to take medicine regularly to keep your white blood cell count down or you may need medicine only part of the time.

Your health care provider will watch your condition and your blood cell count closely. You will have blood tests every few weeks to make sure the medicine is working.

After several years, treatment with drugs may not control the disease. If your condition gets worse, you may be admitted to a hospital and given anticancer drugs (chemotherapy) through a vein (IV).

Another type of treatment is a bone mrarrow transplant. In this procedure, leukemia-producing bone marrow is first destroyed by high doses of drugs and radiation. It is then replaced with healthy stem cells from your own blood or bone marrow or from the marrow of a compatible donor. Stem cells are the cells that form new blood cells. Your health care provider injects the healthy stem cells into your vein to reseed your bones with healthy cells. Only a transplant can cure you but this treatment is very difficult. Sometimes the transplant is not successful, and in rare cases it can be fatal.

How long will the effects last?

Medicine can produce a remission, which means your symptoms temporarily go away. A remission helps many people live a relatively normal life for some years.

How can I take care of myself?

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