CHRONIC MYELOID LEUKEMIA (CML)

CHRONIC MYELOID LEUKEMIA (CML)

Phases of Chronic Myeloid Leukemia

  • Chronic phase: elevated blood counts with enlarged spleen. Patients are asymptomatic or mildly symptomatic.
  • Accelerated Phase: The disease starts getting out of hand. The spleen gets bigger despite treatment. The blasts in the blood and marrow start increasing.
  • Blast Crisis: This is when the disease develops to a full blown leukaemia with marrow blasts more than 20%.

This is largely unknown as in most cases of leukaemia. However, there are few risk factors for Chronic Myeloid Leukaemia as under:

  • More common in males than in females
  • More common in the elderly with a median age at diagnosis of 65 years
  • Exposure to ionising radiation appears to be a risk factor
  • Low Immunity
  • Inflammatory bowel conditions, such as ulcerative colitis or Crohn's disease, have a higher risk.
  • Using pesticides at work

In most patients there are no symptoms, 25% of the patients are detected when the disease has progressed to an acute leukemia. 25% of patients are detected on routine blood test. 50% of patients are detected on investigation, when they have the following symptoms :-

  • Frequent Infections
  • Weight loss
  • Tiredness and looking pale
  • Swollen lymph glands
  • Abnormal bruising or bleeding
  • Abdominal discomfort due to an enlarged spleen
  • Poor appetite
  • Sweating at night
  • Headaches
  • Bone pain

  • Complete Blood Count: The characteristic finding of Chronic Myeloid Leukemia is high white blood cell count with low haemoglobin and increased platelets. Routine examination of the blood gives the diagnosis in most cases.
  • Bone Marrow Examination: This is necessary for confirmation of the diagnosis. In chronic phase, the blast count is less than 5%. In accelerated phase, this is between 5-20% and more than 20% in blast crisis. Bone Marrow Biopsy gives an indication of the degree of fibrosis.
  • Flow Cytometry: This is often used to confirm the type of transformation to acute leukemia.
  • Cytogenetics: This is testing for abnormalities in the chromosomes and is essential for confirmation of the diagnosis
    • Karyotyping: Routine testing for Chromosomes. This establishes the classic translocation between chromosomes 9 and 22.

PCR: This is a test done on the DNA and establishes the amount of BCR/ABL product in the blood or marrow. This test is not only critical to diagnosis, but also essential for following the response to treatment

Following different types of treatment are available for patients with Chronic Myeloid Leukaemia.

  • Targeted therapy
  • Chemotherapy
  • Biologic therapy
  • High-dose chemotherapy with Bone Marrow Transplant

BMT was the treatment of choice for Chronic Myeloid Leukemia until Tyrosine Kinase Inhibitors (TKI) drugs came in use.

When is BMT needed for Chronic Myeloid Leukemia?

  • When patients stop responding to Tyrosine Kinase Inhibitors (TKI)
  • When Chronic Myeloid Leukemia is in Accelerated Phase or Blast Crisis.

How is Conditioning for BMT done in Chronic Myeloid Leukemia?

High to Moderate dose of chemotherapy is generally used in conditioning for BMT in younger patients and Reduced Intensity Conditioning in Older patients.

However a Haploidentical (Half Matched) Donor who has Natural Killer Cell mismatch with the patient provides the best chance of cure

What are the results of BMT in Chronic Myeloid Leukemia?

BMT remains the only curative treatment for Chronic Myeloid Leukemia.

  • Chronic Phase: 90% are cured
  • Accelerated Phase: 40-60% are cured
  • Blast Crisis: 20-40% are cured

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