Chronic Myelogenous Leukemia
Definition of Chronic Myelogenous Leukemia (CML)
Chronic myelogenous leukemia: a dangerous chronic diseases in which too many white blood cells, which belong to the myeloid line of cells made in bone marrow. Early symptoms of this form of leukemia include fatigue and night sweats. The disease is caused by the growth and evolution of abnormal clone of cells that contain chromosomal rearrangement known as the Philadelphia (or Ph) chromosome. Chronic myelogenous leukemia is commonly called CML. It is also known as chronic myelocytic leukemia and chronic granulocytic leukemia.
Bone marrow cells called blasts that normally develop (mature) into several different types of blood cells that have specific jobs in the body. CML affects the blasts that develop into white blood cells called granulocytes. Blast-blast is not mature normally and blast cells that do not become adults found in the blood and bone marrow.
Symptoms of CML
CML usually occurs in people half their age or older, although it can also occur in children. CML typically progress slowly. In the first stage of CML, most people have no symptoms of cancer. When symptoms arise, they may include feelings of having no energy, fever, loss of appetite, and night sweats. Spleen (in the upper right of the abdomen) may be swollen and enlarged with the real.
If there are symptoms, blood tests may be performed to calculate the number of each type of blood cells are different and to test their appearance. If the results from abnormal blood tests, bone marrow biopsy may be done. During this test, a needle is inserted into the bone and a small amount of bone marrow is taken out and examined under a microscope. Other tests that may be performed, including studies of chromosomes (karyotypes) of blood cells and bone marrow and molecular studies of these cells.
Pen-stadiuman of CML: Once CML has been diagnosed, tests are more likely to do to find out if leukemia cells have spread into other parts of the body. This is called a pen-stadiuman (staging). CML advanced through the 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 more sedikiit normal cells.
* Blastic phase - More than 30% of the cells in the blood and bone marrow are blast cells and blast cells may form tumors outside the bone marrow in places such as bone or lymph nodes. This is also called blast crisis.
* Refractory CML - Leukemia cells does not decrease even though treatment is given.
Treatment of CML
Treatment: There are treatments for all patients with CML. These treatments may include:
* Chemotherapy (using drugs to kill cancer cells);
* Other drug therapy (such as Gleevec, a new type of cancer drug)
* Biological therapy (treatment that uses the patient's immune system to fight cancer)
* Radiation therapy (using high-dose x-rays or rays of other high-energy rays to kill leukemia cells);
* High-dose chemotherapy with stem cell transplantation (untu grow into and restore the body's blood cells);
* Donor lymphocyte infusion or DLI (after stem cell transplantation).
* Surgery (splenectomy, surgery to remove the spleen).
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be inserted into the body by a needle in a vein or muscle. Chemotherapy is called systemic treatment because the drug enters the bloodstream, travels throughout the body, and can kill cancer cells throughout the body. Chemotherapy also can be entered directly into the fluid around the brain and spinal cord (spinal cord) through a tube inserted into the brain or back. This is called intrathecal chemotherapy.
Imatinib (Gleevec) is a new type of cancer drug, called tyrosine kinase inhibitors. He was blocking the enzyme, tyrosine kinase, which causes stem cells to develop into white blood cells are much more than is needed by the body. Gleevec has emerged as key drugs that target genes for the treatment of CML.
Radiation therapy uses x-rays or high energy rays to kill cancer cells and shrink tumors. Radiation for CML usually come from a machine outside the body (external radiation therapy) and is sometimes used to relieve symptoms or as part of the therapy given prior to bone marrow transplantation.
Bone marrow transplants are used to replace the patient's bone marrow with healthy bone marrow. First, all the bone marrow in the body is destroyed with high-dose chemotherapy with or without radiation therapy. Healthy marrow is then taken from another person (donor) whose tissue the same or nearly the same as a patient. Donors may be a twin (the best match), a brother or sister, or others who are not related. Healthy marrow from the donor is given to the patient through a needle into the vein, and the marrow replaces the marrow that was destroyed. Bone marrow transplant using marrow from a relative or unrelated to the patient is called 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 taken from patients and treated with drugs to kill any cancer cells. Marrow is then frozen for storage. Patients given high-dose chemotherapy with or without radiation therapy to destroy all the remaining marrow. Marrow that had been stored frozen and then thawed and given back to the patient through a needle into a vein to replace the marrow that was destroyed.
High-dose chemotherapy use stem cell transplant is a method that delivers high-dose chemotherapy and replacing blood-forming cells destroyed by cancer treatment. Stem cells (blood cells are immature) are removed from blood or bone marrow of the patient or donor and are frozen and stored. After the chemotherapy is completed, the stem cells are stored thawed and given back to the patient intravenously. Stem cells that are infusion re-grow into (and improve) the body's blood cells.
Donor lymphocyte infusion (DLI) is a cancer treatment that may be used after stem cell transplantation. Lymphocytes (a type of white blood cells) from stem cell transplant donor are removed from blood donors and may be frozen for storage. Donor lymphocytes thawed if they were previously frozen and then given to the patient through one or more infusions. Lymphocytes see the patient's cancer cells as not belonging to the body and attack them.
Biological therapy tries to make the body attack Cancer. He uses materials made by the body or made in the laboratory to strengthen, directn, or improve the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.
If the spleen is enlarged, the spleen may be removed in an operation called a splenectomy.
Treatment by staging: standard treatment may be considered because of its effectiveness in patients in previous studies, or participation in a clinical trial may be considered.
CMK Phase Chronic: Treatment may be one of the following:
* High-dose chemotherapy with stem cell transplant donor.
* Biological therapy (interferon) with or without chemotherapy.
* Other drug therapy (Gleevec).
* Chemotherapy to reduce the number of white blood cells.
* Surgery to remove the spleen (splenectomy).
* A clinical trial for new treatments.
The Accelerated Phase CML: Treatment may be one of the following:
* Stem cell transplantation.
* Other drug therapy (Gleevec).
* Biological therapy (interferon) with or without chemotherapy.
* High-dose chemotherapy.
* Chemotherapy to reduce the number of white blood cells.
* Transfusion therapy to replace red blood cells, platelets, and sometimes white blood cells, to relieve symptoms and improve quality of life.
* A clinical trial of new treatments.
Blastic Phase CML: Treatment may be one of the following:
* Other drug therapy (Gleevec).
* Chemotherapy using one or more drugs.
* High-dose chemotherapy.
* Donor stem cell transplantation.
* Chemotherapy as a relieving therapy to relieve symptoms and improve quality of life.
* A clinical trial of new treatments.
Chronic myelogenous leukemia who relapse: Treatment may be one of the following:
* Donor stem cell transplantation.
* Donor lymphocyte infusion.
* Biological therapy (interferon).
* A clinical trial of biologic therapy, combination therapy, or other drug therapy (Gleevec).
Prognosis: The chance of healing depends on a number of factors including the phase of CML, the number of blasts in the blood or bone marrow, the spleen size at diagnosis, the patient's overall health, and age of the patient.
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