Chronic Myelogenous Leukemia
Table of Contents
What is chronic myelogenous leukemia?
- Stage Explanation
-
Stages of chronic myelogenous leukemia
- Chronic phase
- Accelerated phase
- Blastic phase
- Meningeal
- Refractory
- Treatment Option Overview
-
How chronic myelogenous leukemia is treated
- Treatment by stage
- Chronic Phase
- Accelerated Phase
- Blastic Phase
- Meningeal Phase
- Refractory
-
- To Learn More
What is PDQ?
PDQ is a computer system that gives up-to-date information on cancer and its
prevention, detection, treatment, and supportive care. It is a service of the National
Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses,
and other health care professionals.
To ensure that it remains current, the information in PDQ is reviewed and updated each
month by experts in the fields of cancer treatment, prevention, screening, and supportive
care. PDQ also provides information about research on new treatments (clinical trials),
doctors who treat cancer, and hospitals with cancer programs. The treatment information in
this summary is based on information in the PDQ summary for health professionals on this
cancer.
How to use PDQ
PDQ can be used to learn more about current treatment of different kinds of cancer. You
may find it helpful to discuss this information with your doctor, who knows you and has
the facts about your disease. PDQ can also provide the names of additional health care
professionals who specialize in treating patients with cancer.
Before you start treatment, you also may want to think about taking part in a clinical
trial. PDQ can be used to learn more about these trials. A clinical trial is a research
study that attempts to improve current treatments or finds information on new treatments
for patients with cancer. Clinical trials are based on past studies and information
discovered in the laboratory. Each trial answers certain scientific questions in order to
find new and better ways to help patients with cancer. Information is collected about new
treatments, their risks, and how well they do or do not work. When clinical trials show
that a new treatment is better than the treatment currently used as "standard"
treatment, the new treatment may become the standard treatment. Listings of current
clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials
are listed in PDQ.
To learn more about cancer and how it is treated, or to learn more about clinical
trials for your kind of cancer, call the National Cancer Institute's Cancer Information
Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is
free and a trained information specialist will be available to answer cancer-related
questions.
PDQ is updated whenever there is new information. Check with the Cancer Information
Service to be sure that you have the most up-to-date information.
What is chronic myelogenous leukemia?
Chronic myelogenous leukemia (also called CML or chronic granulocytic leukemia) is a
disease in which too many white blood cells are made in the bone marrow. The bone marrow
is the spongy tissue inside the large bones in the body. The bone marrow makes red blood
cells (which carry oxygen and other materials to all tissues of the body), white blood
cells (which fight infection), and platelets (which make the blood clot).
Normally, bone marrow cells called blasts develop (mature) into several different types
of blood cells that have specific jobs to do in the body. CML affects the blasts that are
developing into white blood cells called granulocytes. The blasts do not mature and become
too numerous. These immature blast cells are then found in the blood and the bone marrow.
In most people with CML, the genetic material (chromosomes) in the leukemia cells have a
feature that is not normal called a Philadelphia chromosome. This chromosome usually
doesn't go away, even after treatment.
Leukemia can be acute (progressing quickly with many immature blasts) or chronic
(progressing slowly with more mature-looking cancer cells). Chronic myelogenous leukemia
progresses slowly and usually occurs in people who are middle-aged or older, although it
also can occur in children. In the first stages of CML, most people don't have any
symptoms of cancer. A doctor should be seen if any of the following symptoms appear:
tiredness that won't go away, a feeling of no energy, fever, not feeling hungry, or night
sweats. Also, the spleen (the organ in the upper abdomen that makes other types of white
blood cells and filters old blood cells from the blood) may be swollen.
If there are symptoms, a doctor may order blood tests to count the number of each of
the different kinds of blood cells. If the results of the blood test are not normal, the
doctor may order more blood tests. A bone marrow biopsy also may be done. During this
test, a needle is inserted into a bone and a small amount of bone marrow is taken out and
looked at under the microscope. The doctor can then tell what kind of leukemia the patient
has and plan the best treatment.
Separate statements containing patient information on acute lymphocytic leukemia (adult
and childhood), acute myeloid leukemia (adult and childhood), and hairy cell leukemia are
also available in PDQ.
Stages of chronic myelogenous leukemia
Once chronic myelogenous leukemia (CML) has been found (diagnosed), more tests may be
done to find out if leukemia cells have spread into other parts of the body such as the
brain. This is called staging. CML progresses through different phases and these phases
are the stages used to plan treatment. The following stages are used for chronic
myelogenous leukemia:
Chronic phase
There are few blast cells in the blood and bone marrow and there may be no symptoms of
leukemia. This phase may last from several months to several years.
Accelerated phase
There are more blast cells in the blood and bone marrow, and fewer normal cells.
Blastic phase
More than 30% of the cells in the blood or bone marrow are blast cells. The blast phase
of CML is sometimes called "blast crisis." Sometimes blast cells will form
tumors outside of the bone marrow in places such as the bone or lymph nodes. Lymph nodes
are small bean-shaped structures that are found throughout the body. They produce and
store infection-fighting cells.
Meningeal
Leukemia cells are found in the fluid that surrounds the brain and/or spinal cord.
Meningeal CML can occur during the accelerated phase or the blastic phase.
Refractory
Leukemia cells do not decrease even though treatment is given.
How chronic myelogenous leukemia is treated
There are treatments for all patients with chronic myelogenous leukemia. Three kinds of
treatment are used:
- chemotherapy (using drugs to kill cancer cells)
radiation therapy (using high-dose x-rays or other high-energy rays to kill
- cancer cells)
bone marrow transplantation (killing the bone marrow and replacing it
- with healthy marrow).
The use of biological therapy (using the body's immune system to fight cancer) is being
tested in clinical trials. Surgery may be used in certain cases to relieve symptoms.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it
may be put into the body by a needle in the vein or muscle. Chemotherapy is called a
systemic treatment because the drug enters the bloodstream, travels through the body, and
can kill cancer cells throughout the body. Chemotherapy also can be put directly into the
fluid around the brain and spinal cord through a tube inserted into the brain or back.
This is called intrathecal chemotherapy.
Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink
tumors. Radiation for CML usually comes from a machine outside the body (external
radiation therapy) and is sometimes used to relieve symptoms or as part of therapy given
before a bone marrow transplant.
Bone marrow transplantation is used to replace the patient's bone marrow with healthy
bone marrow. First, all of the bone marrow in the body is destroyed with high doses of
chemotherapy with or without radiation therapy. Healthy marrow is then taken from another
person (a donor) whose tissue is the same as or almost the same as the patient's. The
donor may be a twin (the best match), a brother or sister, or another person not related.
The healthy marrow from the donor is given to the patient through a needle in the vein,
and the marrow replaces the marrow that was destroyed. A bone marrow transplant using
marrow from a relative or person not related to the patient is called an allogeneic bone
marrow transplant.
Another type of bone marrow transplant, called autologous bone marrow transplant, is
being tested in clinical trials. To do this type of transplant, bone marrow is taken from
the patient and treated with drugs to kill any cancer cells. The marrow is then frozen to
save it. The patient is given high-dose chemotherapy with or without radiation therapy to
destroy all of the remaining marrow. The frozen marrow that was saved is then thawed and
given back to the patient through a needle in a vein to replace the marrow that was
destroyed.
A greater chance for recovery occurs if a doctor chooses a hospital which does more
than 5 bone marrow transplantations per year.
Biological therapy tries to get the body to fight cancer. It uses materials made by the
body or made in a laboratory to boost, direct, or restore the body's natural defenses
against disease. Biological therapy is sometimes called biological response modifier (BRM)
therapy or immunotherapy.
If the spleen is swollen, a doctor may take out the spleen in an operation called a
splenectomy.
Treatment by stage
Standard treatment may be considered because of its effectiveness in patients in past
studies, or participation in a clinical trial may be considered. Most patients are not
cured with standard therapy and some standard treatments may have more side effects than
are desired. For these reasons, clinical trials are designed to find better ways to treat
cancer patients and are based on the most up-to-date information. Clinical trials are on
going in most parts of the country for patients with CML of any phase. To know more about
clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237);
TTY at 1-800-332-8615.
Treatment may be one of the following:
- 1. Bone marrow transplantation.
2. Biological therapy.
3. Chemotherapy to lower the number of white blood cells.
4. Surgery to remove the spleen (splenectomy).
Treatment may be one of the following:
- 1. Bone marrow transplantation.
2. Chemotherapy to lower the number of white blood cells.
3. Transfusions of blood or blood products to relieve symptoms.
- Treatment may be one of the following:
- 1. Chemotherapy.
2. Bone marrow transplantation.
3. Clinical trials are testing new chemotherapy drugs and new combinations of drugs.
4. Radiation therapy to relieve symptoms caused by tumors formed in the bone.
Treatment may be one of the following:
- 1. Intrathecal chemotherapy.
2. Radiation therapy to the brain.
The treatment depends on many factors. A patient may wish to consider entering a
clinical trial. If the patient has had a bone marrow transplant, the treatment may be
biological therapy or white blood cells from the bone marrow donor may be given to the
patient through a vein.
TO LEARN MORE..... CALL 1-800-4-CANCER
To learn more about chronic myelogenous leukemia, call the National Cancer Institute's
Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By
dialing this toll-free number, trained information specialists can answer your questions.
The Cancer Information Service also has booklets about cancer that are available to the
public and can be sent on request. The following booklets about leukemia may be helpful:
- What You Need To Know About Leukemia
Research Report: Bone Marrow Transplantation
The following general booklets on questions related to cancer may also be helpful:
- Taking Time: Support for People with Cancer and the People Who Care About
- Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
What You Need To Know About Cancer
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again
There are many other places where people can get material and information about cancer
treatment and services. The social service office at a hospital can be checked for local
and national agencies that help with getting information about finances, getting to and
from treatment, getting care at home, and dealing with problems.
For more information from the National Cancer Institute, please write to this address:
- National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
Date Last Modified: 11/97
If you want to know more about cancer and how it is treated, or if you wish to know
about clinical trials for your type of cancer, you can call the NCI's Cancer Information
Service at 1-800-422-6237, toll free. A trained information specialist can talk
with you and answer your questions.
Source: National Cancer Institute
National Institutes of Health
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