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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Leukemia: Chronic Myelogenous
What is chronic myelogenous leukemia?
Chronic myelogenous leukemia (CML) is a rare,
life-threatening cancer that affects the bone marrow. Marrow is
the soft, fatty tissue inside the bones. The cancer can
cause the number of white blood cells in the bone marrow
to be 20 to 40 times higher than normal. These cancerous
white blood cells crowd out healthy blood cells in the bone
marrow.
How does it occur?
The cause of this cancer is not known. However, often it
appears to be related to the presence of an abnormal
chromosome called the Philadelphia chromosome.
CML develops mainly in people who are middle-aged and
sometimes in people who are older. Men and women are
affected equally.
What are the symptoms?
The symptoms vary a lot. Some people have no symptoms.
Your health care provider may discover the disease during a
routine blood test. Or during a physical exam your provider
may find that you have an enlarged spleen.
When they occur, symptoms may include:
- loss of appetite and weight
- fever and sweating at night
- fatigue or low energy
- bone pain
- a sense of fullness in the upper left side of the
abdomen.
The disease can have a chronic phase and an accelerated
phase. In about 1 person in 4 the chronic phase develops
into an accelerated phase, which is more serious. With
frequent checkups, your health care provider will recognize
a change in phases.
How is it diagnosed?
Your health care provider will ask about your medical history
and examine you. He or she will check for an enlarged
spleen.
You will need blood tests, including:
- complete blood count
- platelet count
- leukocyte alkaline phosphatase.
If it's not possible to do chromosome testing for the
Philadelphia chromosome, sometimes a blood test called a
Southern blot can be done.
You may have a bone marrow biopsy. In this procedure, a
small sample of bone marrow is taken, usually from the
pelvic bone, and sent to the lab for tests. First your
health care provider numbs the area over the bone and then
uses a needle to get the sample. Usually this biopsy is
done in your provider's office.
How is it treated?
The chronic phase of CML is often controlled by medication
to keep the white blood cell count normal. Examples of such
medicines are hydroxyurea, busulfan, and interferon. With
treatment, many people have no symptoms from the disease.
You may need to take medication regularly to keep your white
blood cell count down or you may need medication only part
of the time.
Your health care provider will watch your condition and your
white blood cell count closely. You will have blood tests
every few weeks to make sure the medication is working.
After several years, treatment with drugs may not control
the disease. If your condition gets worse, you may be
admitted to a hospital and given anticancer drugs
(chemotherapy) through a vein (IV).
Another type of treatment is a bone marrow transplant. In
this procedure, leukemia-producing bone marrow is first
destroyed by high doses of drugs and radiation. It is then
replaced with healthy bone marrow cells from a compatible
donor. Your provider injects the healthy marrow cells into
your vein to reseed your bones with healthy bone marrow
cells.
How long will the effects last?
Medication can produce a remission, which means your
symptoms temporarily go away. A remission helps many people
live a relatively normal life for some years.
Chronic myelogenous leukemia can sometimes be cured with a
bone marrow transplant.
How can I take care of myself?
- Follow your health care provider's recommendations.
- Eat a healthy, well-balanced diet.
- Get plenty of rest and regular exercise according to
your provider's recommendations.
- Ask your health care provider before you take any
medication, including nonprescription drugs.
- Discuss your questions and concerns with your health care
provider.
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