Chronic Myeloid Leukemia Diagnosis and Treatment
Chronic myeloid leukemia (CML), also can be known as Chronic Myelogenous Leukemia. It is a sort of cancer that develops in the blood-forming cells of the bone marrow and invades the blood.
Chronic myeloid leukemia (CML) is called by several other names, including Chronic granulocytic leukemia and Chronic myelocytic leukemia.
CML basically results from an acquired (not existing at birth) or a genetic injury to the DNA of a single bone marrow cell. The mutated cells mainly multiplied into numerous CML cells. The outcome of the uncontrolled growth of CML cells in the marrow is an increase in the number of CML cells in the blood. Chronic myeloid leukemia does not entirely interfere with the development of the mature red cells, white cells and platelets.
Causes of CML: No one is born with CML. It happens when there is an injury to the DNA of a single bone marrow cell.
Signs & Symptoms: Unlike other forms of leukemia, CML is a slow-growing disease and does not completely interfere with the development of red blood cells, white blood cells and platelets. Therefore, the respective patients may have the CML, but have no signs and symptoms. Those with symptoms often report:
• Night sweats
• Being very tired or tiring easily
• Shortness of breath during basic, everyday activities
• Unexplained weight loss
• Enlarged spleen
• Dragging feeling on the upper left side of the abdomen under the ribs
• A decrease in red blood cells)
• Inability to tolerate warm temperatures.
Diagnosis: In order to diagnose CML, the healthcare team uses numerous tests to analyze the marrow and blood cells.
Complete Blood Count (CBC): This test is used to measure the number and types of cells in the blood. People with CML often have:
• Decreased hemoglobin concentration
• Increase in count of WBC, often quite high levels
• Possible increment or decrement in the number of platelets based on the severity of the person’s CML.
Blood cells are stained (dyed) and examined with a light microscope. These samples show a:
• Specific pattern of white blood cells
• Leukemic blast cells and the promyelocytes
• Larger proportion of the maturing and fully matured WBC.
These promyelocytes, myelocytes and blast cells normally do not exist in the blood of the healthy individuals.
Bone Marrow Aspiration and Biopsy: These tests are used to examine marrow cells in order to find abnormalities and are generally done at the same time.
Cytogenetic Analysis: This test helps in measuring the number as well as structure of the chromosomes. Bone marrow samples are examined in order to confirm the blood test findings and to identify if there are changes of chromosomal or abnormalities, such as the Philadelphia (Ph) chromosome.
The existence of the Ph chromosome in the marrow cells, along with the high WBC count and other characteristic blood and marrow test findings, confirms the diagnosis of CML.
FISH (Fluorescence In Situ Hybridization): This is the most sensitive way for detecting CML than the standard cytogenetic tests that recognise the Ph chromosome. FISH is a sort of quantitative test that is able to identify the presence of the BCRABL gene.
Polymerase Chain Reaction (PCR): The BCR-ABL gene can be detectable by the molecular analysis. A quantitative Polymerase Chain Reaction test is the most sensitive molecular testing method. This must be performed with blood or with the bone marrow cells.
Chronic Myeloid Leukemia Stages: Doctors use diagnostic testing to determine a patient’s phase of CML. There are three phases of CML. They are:
• Chronic phase
• Accelerated phase
• Blast crisis phase
Treatment: Healthcare providers who are specialized in treating patients with the CML are addressed as “hematologist/oncologists.” These healthcare professionals can determine the most precise and appropriate treatment options for each and every patient.
Patients can be treated in various ways.
Leukapheresis: It is the removal of white blood cells by a machine that is similar to a dialysis machine. Leukapheresis should be used if the chronic phase Chronic Myeloid Leukemia is diagnosed during the initial month of pregnancy, when rest treatments could be hazardous to the fetal development.
Tyrosine Kinase Inhibitor Therapy: TKIs are medications that target the abnormal BCR-ABL protein that is responsible for causing the uncontrolled Chronic Myeloid Leukemia cell growth. This protein, made by the BCR-ABL gene, is located on or near the surface of cells and is called a “tyrosine kinase.” TKIs inhibit (block) the BCR-ABL protein from sending the signals that cause the growth of abnormal cells. Three Tyrosine Kinase Inhibitor drugs are approved as the first-line treatment for chronic phase CML and all three are good options for newly diagnosed patients. These drugs are:
• Imatinib mesylate (Gleevec)
• Dasatinib (Sprycel)
• Nilotinib (Tasigna)
The existing drugs Bosutinib (Bosulif) and Ponatinib (Iclusig) are another treatment option.
Imatinib mesylate (Gleevec): Gleevec is the oldest TKI therapy drug and has been approved by the US Food and Drug Administration (FDA) in order to treat:
• Adult patients who’ve newly diagnosed with the Ph+ CML in chronic phase
• Adults patients with the Ph+ CML in blast crisis, accelerated phase, or in the chronic phase after the failure of therapy of interferon-alpha. Interferon is basically used as an initial therapy in special junctures or circumstances; for instance CML that is newly diagnosed during the pregnancy.
• Pediatric patients who have recently been diagnosed with Ph+ CML in the chronic phase.
How Does Imatinib Work: It prevents a BCR-ABL protein from exerting its role in the oncogenic pathway in chronic myeloid leukemia (CML)
Imatinib 400 mg directly inhibits the constitutive tyrosine kinase activity. Imatinib binds to BCR-ABL kinase domain by preventing the transfer of a phosphate group to tyrosine on the protein substrate and the subsequent activation of phosphorylated protein. As a result, the transmission of proliferative signals to the nucleus is blocked and leukemic cell apoptosis is induced.
Side Effects: Common side effects of Veenat 400 mg (Imatinib) include vomiting, diarrhea, muscle pain, headache, and rash.
How long can you live with Chronic Myeloid Leukemia: The five year survival rate of people with CML depends on the phase of the disease, other biological characteristics of the CML, and the diseases’s response to the treatment.
Chronic Myelogenous Leukemia Treatment Drugs List:
ICLUSIG (Ponatinib)
AGRYLIN (Anagrelide)
BOSULIF (Bosutinib)
MYLERAN (Busulfan)
GLEEVEC (imatinib mesylate 400 mg )
SYNRIBO (Omacetaxine)
BENDIT (Bendamustine)
ISENTRESS (Raltegravir)
HYDREA (Hydroxyurea 500 mg)
