Chronic Myeloid Leukaemia: Symptoms, Causes & Treatment

Chronic myeloid leukaemia is a type of blood cancer that begins in the bone marrow's myeloid cells or stem cells. Other names for the illness include chronic granulocytic leukaemia and chronic myelogenous leukaemia. 

1. A genetic alteration (mutation) in the bone marrow-produced stem cells leads to CML. The mutation makes the stem cells create an excessive number of immature white blood cells. 

2. Additionally, it causes a decline in the number of other blood cells, like red blood cells and chromosomes, or collections of DNA, which may be altered.

3. Here a piece of DNA from one chromosome switches places with a piece from another within each stem cell. 

The "Philadelphia chromosome" is the name given to this mutation. Although the exact cause of this is unknown, it cannot be passed down to the offspring (child) and is not a trait that one is born with.

Now, many CML patients are leading a normal life, all thanks to therapy, which has transformed the condition from a life-threatening sickness.

About 15% of all leukaemia patients suffer mainly from chronic myeloid leukaemia. CML can strike anyone at any age. However, it usually strikes elderly people.  

There are four chronic myeloid leukaemia stages:

1. Chronic CML: The word "chronic" frequently denotes a persistent condition. This phrase CML refers to the proportion of blasts (immature white blood cells) in the bone marrow and blood. 

1. When suffering from chronic CML, about 10% of the blood and bone marrow cells are blasted. For about 80% to 90% of cases, CML is chronic for most patients. However, patients suffering from chronic CML may or may not experience symptoms.

2. Accelerated CML: In this stage, blasts comprise 10% to 19% of the blood or bone marrow cells. Basophils are white blood cells that secrete enzymes to enhance blood flow and avoid blood clots. One might have higher basophil levels if he/she has CML.

3. Blast (Blast Crisis) CML: Blast CML is life-threatening. Tests have shown that blasts make up 20% or more cells in the blood or bone marrow. People with blast phase CML have prominent symptoms like fatigue, fever, weight loss and shortness of breath. 

4. Resistant CML: Resistant CML is a condition that recurs after therapy or doesn't improve the patient’s condition.

Different phases of CML may have different symptoms. A person might not have any symptoms throughout the chronic stage. But, when they show up, they are non-specific, which means they may resemble the symptoms of numerous other illnesses. 

The significant chronic myeloid leukaemia symptoms include: 

1. Weakness

2. Tiredness

3. Shortness of breath

4. Night sweats

5. Bone pain

6. Weight loss

7. Fever

8. Feeling bloating in the stomach

9. Feeling full after very easily

10. Tenderness in the left side of the stomach

11. Pale skin and shortness of breath

12. A high temperature

13. Bruising and bleeding easily

14. Frequent infections

The exact cause of CML is not well understood, but researchers believe that a combination of genetic and environmental factors plays a role in its development.

Chronic Myeloid Leukaemia Risk Factors

The risk factors that increase an individual's likelihood of developing CML are as follows. 

1. Older Age: The risk of getting CML goes up with age. The average age of those who receive a CML diagnosis is 64.

2. Gender: It is unknown why men are significantly more likely than women to have this condition.

3. Exposure to Radiation: The risk of developing CML rises with high-dose radiation exposure (such as being a survivor of an atomic bomb explosion or nuclear reactor accident). 

4. Family History: While most CML cases are not inherited, having a family member with CML or another type of leukaemia may slightly increase the risk of developing the disease.

5. Previous Cancer Treatments: Individuals who have received certain types of chemotherapy or radiation therapy for other cancers may have a slightly higher risk of developing CML later in life. However, the absolute risk remains relatively low.

It is believed that mutations are to be blamed for the progression of CML. Therefore, there are no known preventive measures that can guarantee the avoidance of CML.

However, it is important to focus on overall health and well-being, as maintaining a healthy lifestyle may positively impact overall cancer risk. Here are some general recommendations for maintaining good health:

1. Regular Check-ups: Regular visits to healthcare providers can help detect any health issues early on and allow for prompt intervention if necessary.

2. Healthy Diet: Eating a balanced diet that includes a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats is important for overall health. While it may not prevent CML, a nutritious diet can support a strong immune system and help maintain overall well-being.

3. Physical Activity: Engaging in regular physical activity, such as walking, swimming, or cycling, can help maintain a healthy weight, improve cardiovascular health, and boost overall well-being.

4. Avoiding Exposure to Radiation and Harmful Chemicals: Minimizing exposure to unnecessary radiation and harmful chemicals, such as certain industrial chemicals or pesticides, may reduce the risk of developing certain cancers, although the specific link to CML is not established.

5. Smoking and Alcohol: Avoiding tobacco use and limiting alcohol consumption can reduce the risk of various types of cancer, including some forms of leukaemia. Quitting smoking and seeking help for alcohol dependency are important steps towards better health.

Chronic Myeloid Leukemia (CML) is typically diagnosed through a combination of medical history evaluation, physical examination, blood tests, and bone marrow tests. Chronic myeloid leukaemia pathology outlines include:

1. Physical Exam: The doctor will examine and measure the blood pressure and pulse, among other vital indicators. To evaluate whether the lymph nodes, spleen, or belly are swollen, he or she will also examine these parts.

2. Complete Blood Count (CBC): This test will measure the number of different types of blood cells. In CML, an elevated white blood cell count, specifically an increased number of immature white blood cells called blasts, may indicate the presence of the disease. 

1. The blood tests may also include a peripheral blood smear to examine the appearance of the blood cells under a microscope.

3. Bone Marrow Aspiration or Biopsy: Pathologists take small fluid or tissue samples for genetic tests. They would then perform tests to analyse abnormal cells’ genetic makeup.

4. Genetic Tests: To determine if the Philadelphia chromosome or the BCR-ABL gene is present in blood or bone marrow samples, specialised techniques like the fluorescence in situ hybridisation (FISH) analysis and the polymerase chain reaction (PCR) test are used.

5. Computed Tomography (CT) Scan: This test is used to determine the effect of CML in another body part.

6. Ultrasound: Medical professionals may use this test to assess whether the spleen is larger than usual. One significant symptom of CML is an enlarged spleen.

How to Prepare for Doctor’s Consultation?

The first step towards diagnosing CML is the doctor checking the patient's overall health and the normal functioning of their vital organs.

There are some things that the patient must keep in mind to prepare for the doctor’s consultation appointment. These include:

1. Taking a prior appointment

2. Enlisting symptoms

3. Writing down personal information, including medical history

4. Making a list of questions for the doctor

What to Expect from the Doctor?

The doctor will ask the person some questions that will allow them a proper diagnosis of the problem. Some of the most common questions include: 

1. The duration for which a person has been experiencing the symptoms

2. The frequency and severity of the symptoms 

3. Things that provide relief in the symptoms

4. Things that worsen the symptoms 

Questions the Patient Can Ask?

These are some of the questions that one should ask their doctor.

1. What phase am I in with chronic myeloid leukaemia?

2. What alternatives do I have for treatment?

3. How will my medical therapy feel?

4. Can I go to work while receiving treatment?

5. How frequently will blood tests be conducted to monitor my treatment's effectiveness?

6. What are the possibilities that CML will remit?

7. In my situation, would a stem cell transplant be beneficial?

8. Who can I contact regarding controlling my medical expenses?

Treatment for chronic myelogenous leukaemia aims to eradicate blood cells that carry the faulty BCR-ABL gene, which is the source of the excess number of diseased blood cells. Most patients start their course of treatment with certain medications that could lead to a long-term remission of their illness.

1. Chemotherapy: Chemotherapy is a medication therapy that destroys the body's rapidly proliferating cells, including leukaemia cells. When treating aggressive, chronic myelogenous leukaemia, chemotherapy medications are occasionally coupled with targeted pharmacological therapy. Depending on the medication that the patient is taking, chemotherapy medications can have side effects.

2. Targeted Drug Therapy: To combat cancer, targeted medications target a particular kind of cancer cells that promotes their growth and multiplication. These medications target tyrosine kinase, a protein made by the BCR-ABL gene, in chronic myelogenous leukaemia. Chronic myeloid leukaemia medicine that prevents tyrosine kinase activity includes:

1. Imatinib (Gleevec)

2. Dasatinib (Sprycel)

3. Nilotinib (Tasigna)

4. Bosutinib (Bosulif)

5. Ponatinib (Iclusig)

3. Bone Marrow Transplant: The only option for permanent recovery from chronic myelogenous leukaemia is a bone marrow transplant, commonly known as a stem cell transplant. However, because bone marrow transplants are risky and have a high probability of significant consequences, they are often only used for patients who haven't responded to previous treatments. 

4. Clinical Trials: Clinical trials investigate innovative methods of administering existing medications or the most recent illness treatments. Even though participating in a clinical trial for chronic myelogenous leukaemia may allow one to try the newest medication, it cannot promise a cure. 

5. Supportive Care: Alongside the main treatment approaches, supportive care plays a crucial role in managing CML treatment's side effects and complications. Supportive care may include medications to manage symptoms like nausea, pain, or infections and blood transfusions to address anaemia or platelet deficiencies.

Cost of Chronic Myeloid Leukaemia Treatment

The cost of CML treatment in India depends on several factors, including the stage of cancer, treatment modality used, patient’s age, patient’s comorbidities, hospital type and location, doctor’s experience, insurance coverage and much more.

To know the exact cost of CML treatment in India, one must visit their doctor, or the below table provides the approximate cost of various treatment modalities for CML.

Chronic Myeloid Leukaemia Survival Rate

The survival rate for CML has significantly improved over the past few decades due to advancements in treatment options. However, it's important to note that survival rates can vary based on several factors, including the phase of the disease, age of the patient, response to treatment, and overall health. 

The five-year survival rate represents the percentage of people who are alive five years after their diagnosis. For CML, the overall five-year survival rate is estimated to be 90%. Only 22% of CML patients were alive five years before TKI. The best source of information about what to anticipate if one has CML is the doctor who treats him/her.

Chronic Myeloid Leukemia (CML) is a type of cancer that can lead to various risks and complications if not properly managed. Here are some of the risks and complications associated with CML:

1. Hepatomegaly and/or Splenomegaly: Splenomegaly is another name for an enlarged spleen. It is a sign of the underlying condition, which is the CML. Splenomegaly is brought on by benign or malignant growths as well as an excessive generation of cells.

2. Worsening Anaemia: Anaemia is frequently present in chronic phase chronic myeloid leukaemia (CML-CP) patients at diagnosis, but it is unclear how this affects the prognosis. Patients with moderate anaemia have more aggressive characteristics, such as higher WBC counts and greater percentages of myeloblasts and basophils, compared to those with non-moderate anaemia, including a higher proportion of intermediate-high Sokal hazards. 

3. Clotting or Bleeding Complications: There may be a change in the platelet count due to CML, which can further lead to clotting and bleeding complications.

4. Recurrent Infections: An increased risk of viral infections, particularly the reactivation of latent viruses like varicella zoster and hepatitis B, exists in patients diagnosed with CML. As evidenced by the large number of patients who experience viral reactivation in the chronic phase, this is probably due to the disease.

5. Fatigue: There is a serious loss of energy that cannot be remedied by sleep. It can be difficult to participate in daily activities if a patient has CML fatigue because it doesn't get better or go away with time. 

Risk of Delayed Treatment

Delaying the diagnosis and treatment of CML can have serious consequences for the patient's health. To attain the best results, treatment must begin right away after a diagnosis. The following are potential dangers of delaying CML treatment:

1. The illness can advance quickly, increasing the number of cancer cells in the bone marrow and blood. As a result, there may be a greater burden of leukaemia cells present throughout the body and more extensive organ involvement.

2. Delaying treatment may make CML symptoms, including fatigue, weakness, unexplained weight loss, abdominal discomfort, and an enlarged spleen, worse or continue to exist. 

3. Untreated or undertreated CML can lead to serious complications

4. Delaying treatment can raise the possibility that CML will develop into an acute leukaemia-like condition that is more aggressive and challenging to treat. This change is frequently linked to worse outcomes and few available treatments.

When to See a Doctor?

It is important to consult a doctor if one experiences any concerning symptoms or risk factors associated with CML Here are some situations when one should seek medical attention:

1. Persistent fatigue

2. Unexplained weight loss

3. Abdominal discomfort

4. Unusual sweating

5. Bruising and bleeding

6. Recurrent infections

Eating habits often change for most patients when receiving cancer therapy. It has been noticed that radiation has the potential to cause excessive weight loss, lean body mass loss, and malnutrition. To maintain weight, it's necessary to make an effort to consume enough protein, carbohydrates, and fats. 

A healthy diet that includes food items rich in nutrition, minerals, and lots of water to stay hydrated might also help the patient maintain their weight. The Leukaemia and Lymphoma Society (LLS) provides the following general dietary recommendations:

1. A variety of vegetables, including legumes

2. Whole fruits

3. Whole grains

4. Fat-free or low-fat dairy

5. Food rich in proteins

6. Seafood, lean meats, poultry, beans, soy, and eggs

7. Healthy oils, such as olive oil

8. Water, tea, or coffee for hydration

Chronic myeloid leukaemia (CML) is frequently known as cancer of the blood and bone marrow. Receiving treatment when suffering from the early, chronic stage of CML can help stop the condition from progressing to a more serious stage.

You should consult a haematologist-oncologist as soon as you are diagnosed. They'll develop a therapy strategy for you, with the treatment's objective being to eliminate the leukaemia blood cells from your body and replenish healthy blood cells to a normal level. 

So, reach out to HexaHealth to know about the newer therapies or clinical trials that could allow you to be CML-free if you have the disease. Also, via HexaHealth, you would connect with the best oncologists to battle chronic myeloid leukaemia.

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