Chronic Myeloid Leukemia (CML)

Chronic myeloid leukemia (CML) is a type of cancer that affects the blood and bone marrow. It is characterized by the uncontrolled growth of myeloid cells, which are a type of white blood cell responsible for fighting infection.

Causes and Risk Factors

The exact cause of CML is not known, but it is associated with a genetic mutation in the BCR-ABL1 gene. This mutation leads to the production of an abnormal protein that promotes the growth and survival of cancer cells. Risk factors for CML include:

• Age: CML is more common in adults, with most cases occurring in people over 60 years old.
• Exposure to radiation: People who have been exposed to high levels of radiation, such as those who have undergone radiation therapy or worked with radioactive materials, are at increased risk of developing CML.
• Genetic disorders: Certain genetic disorders, such as Down syndrome, may increase the risk of developing CML.

Symptoms

The symptoms of CML can vary from person to person and may include:

• Fatigue or weakness
• Weight loss
• Night sweats
• Pain or discomfort in the abdomen, bones, or joints
• Swollen lymph nodes or spleen
• Easy bruising or bleeding
• Frequent infections

Diagnosis

CML is typically diagnosed through a combination of physical examination, medical history, and laboratory tests. These may include:

• Complete blood count (CBC): A test that measures the levels of different types of blood cells.
• Bone marrow biopsy: A procedure in which a sample of bone marrow is removed and examined for cancer cells.
• Cytogenetic analysis: A test that examines the chromosomes of cancer cells for genetic mutations.
• Molecular testing: A test that detects the presence of specific genetic mutations, such as the BCR-ABL1 gene fusion.

Treatment

The treatment of CML usually involves a combination of medications and other therapies. These may include:

• Tyrosine kinase inhibitors (TKIs): Medications that target the abnormal protein produced by the BCR-ABL1 gene fusion.
• Chemotherapy: Medications that kill cancer cells or slow their growth.
• Interferon therapy: A type of immunotherapy that helps to boost the body's immune response against cancer cells.
• Bone marrow transplantation: A procedure in which healthy bone marrow is transplanted into the body to replace damaged or diseased bone marrow.

Prognosis

The prognosis for CML has improved significantly in recent years, thanks to advances in treatment. With proper treatment, many people with CML can experience long-term remission and live for many years after diagnosis. However, the disease can still be challenging to manage, and regular monitoring and follow-up care are essential to ensure the best possible outcome.

Frequently Asked Questions (FAQs)

What is Chronic Myeloid Leukemia (CML)?
A type of cancer that affects the white blood cells and tends to progress slowly over time.

What are the common symptoms of CML?
Fatigue, weight loss, night sweats, and enlarged spleen, although some patients may be asymptomatic.

What causes CML?
Typically associated with a chromosomal abnormality called the Philadelphia chromosome, resulting from a translocation between chromosomes 9 and 22.

How is CML diagnosed?
Through blood tests, bone marrow biopsy, and cytogenetic or molecular testing to detect the Philadelphia chromosome or BCR-ABL1 gene fusion.

What are the phases of CML?
Chronic phase, accelerated phase, and blast crisis, each with distinct clinical and laboratory features.

What is the goal of treatment for CML?
To achieve a complete cytogenetic response, major molecular response, or complete molecular response, and to prevent disease progression.

What are the common treatments for CML?
Tyrosine kinase inhibitors (TKIs), such as imatinib, dasatinib, and nilotinib, as well as allogeneic stem cell transplantation in some cases.

Can CML be cured?
While some patients may experience long-term remission or complete molecular response, it is generally considered a manageable chronic condition rather than curable.

What are the potential side effects of CML treatment?
Varying depending on the specific treatment, but may include gastrointestinal symptoms, fatigue, and hematologic toxicity.

How often should patients with CML be monitored?
Regularly, typically every 3-6 months, to assess response to treatment, monitor for potential side effects, and adjust therapy as needed.