CML: Symptoms, diagnosis, examination and treatment

CML is an abbreviation for chronic myelogenous leukemia. This is a form of leukemia that accounts for approximately 20% of all leukemia forms. The disease takes place in the bone marrow and is dormant. The complaints are not always clearly identifiable and approximately 50% of CML cases are discovered by chance. The disease is mainly diagnosed in people over 50. what are the symptoms of CML? How does this disease progress and how do you treat it?

Symptomatology

  • Anemia: Anemia caused by a lack of red blood cells. It can be recognized by pale skin, shortness of breath during physical activities, persistent fatigue and dizziness.
  • Unexplained bruising and increased risk of bleeding due to a lack of platelets.
  • Discomfort that can be attributed to a swollen spleen or liver. These discomforts consist of a tense feeling and/or stabbing pain on the left or/and right side (at the level of your diaphragm) of the torso. A tense feeling can be heard with mild swelling and pain can be heard when the spleen and/or liver swells further. Increasing degrees of pain or swollen feeling is an indication of increasing swelling.
  • Pain in the bones
  • Night sweats
  • Unexplained weight loss

Research and diagnostics

Blood tests

Blood is taken and a smear is made. It is then examined in the laboratory and the number of platelets, red blood cells and white blood cells are examined. For someone with CML, the following results will be obtained from the examination.

  • A high white blood cell count and immature white blood cells,
  • A low number of red blood cells,
  • Possibly too high a platelet count (does not always occur).

However, it does not mean that the patient actually has CML. There are several diseases where the results of the test are the same as the results above. The suspicion can be confirmed by further research into the Philadelphia syndrome.

Cytogenetic research

This examination consists of a bone marrow puncture, during which bone marrow cells are examined. We look for any abnormalities in chromosomes. With this test, Philadelphia syndrome can be found and confirmed CML in combination with the blood test.

Molecular research

In this study, the BCR-ABL proteins are measured. These are abnormal proteins that cause the production of new white blood cells to go wrong. Due to this protein, the production of white blood cells is too high and the white blood cells are produced abnormally (immature). This test is a supplement to the other tests to definitively diagnose CML.

Therapy

Doctors pay attention when choosing medication;

  • The form of leukemia; chronic myelogenous leukemia (CML), acute myeloid leukemia (AML), acute myeloid leukemia, acute lymphocytic leukemia). The treatment of acute leukemia is more difficult because acute leukemia is more difficult to combat.
  • How extensive the disease; what stage is the person in question in?
  • Data from chromosome research.
  • The age and physical condition.
  • And of course on personal wishes and circumstances.

Bone marrow or stem cell transplant:

This treatment offers a small chance of complete recovery, but offers anything but certainty. It is a very risky operation with a risk of rejection, infections and the chance of recurrence. These risks mean that this treatment is only considered as a last option.

Tyrosine kinase inhibitors:

Such as imatinib, nilotinib or dasatinib. This medication is considered the first choice in the treatment of CML. The drug inhibits rapid cell division caused by the BCR-ABL protein (which in turn is caused by Philadelphia syndrome). Complete healing is not possible, but research has shown that the amount of incorrect white blood cells has decreased significantly and has been replaced by more red blood cells. However, it sometimes happens that users of the drug become resistant. In this case, another suitable inhibitor is sought.

Possible side effects: diarrhea, eczema-like skin abnormalities, (rarely) liver function disorders, nausea, muscle pain or cramps in the muscles and fluid retention (usually around the eyes and in the feet).

Interferon

A form of immunotherapy. Interferon is a substance that is already in our body anyway. Interferon affects the growth of leukemia cells and is administered by injection.

Possible side effects: feeling of depression, flu-like symptoms and skin irritation.

Chemotherapy

In some cases chemotherapy is also given. The only disadvantage to this is that healthy cells are also affected. Sometimes a bone marrow transplant must be performed afterwards because the cells in the bone marrow have also disappeared.

Possible side effects : chills, fever, sore throat, leg ulcers, infections, fatigue, dizziness, confusion, unusual bleeding/bruising, fast heart rate, shortness of breath and difficulty sleeping.

Prognosis/course

CML consists of three phases, with the last phase being the transition to Acute Myeloid Leukemia. For some people it may take years before you notice anything about the disease

  • Phase 1: chronic phase; less than 10% leukemic blast cells. This phase can sometimes last 5 to 6 years.
  • Phase 2: acceleration phase; 10% – 19% leukemic blast cells. Life expectancy in this phase is approximately 1 year.
  • Phase 3: blast phase; more than 20% leukemic blast cells. The blast crisis occurs in this phase. The blast crisis can be recognized by severe fatigue, enlarged spleen and fever. In this phase, life expectancy is only 5 months, depending on the percentage of leukemic blast cells in the blood.

If nothing is done about the leukemia, the blast crisis will cause death.

Complications

CML involves anemia. This is iron deficiency. The bottom line is that there are too few red blood cells in your body, which makes you tired. Red blood cells contain hemoglobin and these cells transport oxygen throughout the body. A reduction in red blood cells therefore means a reduction in oxygen transport. To keep this going, the heart starts beating faster. A complication due to too few platelets can include palpitations/problems.

For the rest, there is a risk of serious internal bleeding, dehydration due to increased perspiration and underweight due to an increased metabolism.