Medical Conditions

CML is a form of leukemia. CML is a type of myeloproliferative disease and is characterized by an increase and deranged growth of mainly myeloid cells in the bone marrow followed by accumulation in the cells of the blood. CML is a clonal bone marrow stem cell disorder. CML is associated with a characteristic chromosomal translocation called the Philadelphia chromosome.

Chronic Myelogenous Leukemia (CML) Facts

• CML accounts for about 15% of all leukemia cases in the United States.

• Over 21,500 people are living with CML.
• CML most often occurs in people over age 50.
• Only 10% of people diagnosed with CML are under the age of 20.
• More males than females are diagnosed with CML.

Prognosis for CML
The prognosis for a patient with CML is tied to the stage of the disease. Biological drug therapy such as imatinib (Glivec) has dramatically increased survival rates for patients who can't have intensive treatment. Not all patients respond to Glivec and others become resistant to it over time. There are new therapies available to patients that do not respond to Glivec. Over 50% of people who have undergone intensive treatment with bone marrow or stem cell transplant will live 15 years or more. CML survival really depends on you. In some people it develops very slowly while in others it develops more rapidly. If your CML is in the blast phase and does not respond to treatment you may only have months to live.

What to expect when you get diagnosed with CML
CML may be suspected by your doctor if you have an abnormal complete blood count (CBC). A series of diagnostic tests will be performed to rule out other blood disorders and medical problems. A blood chemistry test may be performed. This test can measure organ function and may aid in a diagnosis. A bone marrow biopsy will be performed. In a bone marrow biopsy a sample of bone marrow is taken from the hip bone or another large bone. A bone marrow biopsy measures the blast count. While blast cells are seen on blood smear in 90% of cases a bone marrow biopsy is the only sure way to determine whether leukemia cells are in the bone marrow.

Additional specialized testing of the blood and bone marrow may be performed to determine the presence of the Philadelphia chromosome or BCR-ABL gene. These tests include fluorescence in situ hybridization (FISH) analysis and polymerase chain reaction (PCR) test.

Phases of CML
There are three phases of CML. To determine the phase (agressiveness of the disease) your doctor will measure the proportion of diseased cells to healthy cells in your blood or bone marrow. A higher proportion of diseased cells means chronic myelogenous leukemia is at a more advanced stage. Phases of CML include chronic (earliest and best response to treatment), accelerated (transitional phase, disease becomes more aggressive), and blastic (severe, aggresive phase - life threatening).

Treatment for CML
The goal of CML treatment is to eliminate the blood cells that contain the abnormal BCR-ABL gene that causes the overabundance of diseased blood cells. Targeted drugs go after the protein produced by the BCR-ABL gene — tyrosine kinase. Imatinib is the initial treatment for most people diagnosed with chronic myelogenous leukemia. If the disease doesn't respond or becomes resistant to imatinib, doctors may consider other targeted drugs or other treatments. Side effects of these targeted drugs include swelling or puffiness of the skin, nausea, muscle cramps, rash, fatigue, diarrhea, and skin rashes. No safe point has been determined for CML patients to stop taking targeted drugs. Most CML patients continue taking targeted drugs even when blood tests reveal a remission. Other treatments for CML include blood stem cell transplant, chemotherapy, biological therapy, and clinical trials.

What are symptoms of CML?
CML does not always have obvious symptoms and signs in the early phase. People can often live for months or years without realizing they have CML. Symptoms of CML may include easy bleeding, tiredness, fever, frequent infections, weight loss, loss of appetite, pain or fullness on left side below ribs, pale skin, night sweats. 

Questions to ask your doctor

• Can you explain what my test results mean?
• Do you recommend any other tests or procedures?
• What is the phase of my CML?
• What are my treatment options?
• What side effects are likely with each treatment?
• How likely is it that I'll achieve remission with the treatments you recommend?
• How quickly must I make a decision on my treatment?
• Should I get a second opinion from a CML specialist?

Alternate Names for CML
Chronic myelogenous leukemia is also called:
Chronic granulocytic leukemia