Main Campus: Chesterfield, MO 63017 | 
Chronic myelogenous leukemia (CML)
CML; Chronic myeloid leukemia; Chronic granulocytic leukemia; Leukemia - chronic granulocytic
Chronic myelogenous leukemia (CML) is cancer that starts inside bone marrow. This is the soft tissue in the center of bones that helps form all blood cells.
Cancer
Cancer is the uncontrolled growth of abnormal cells in the body. Cancerous cells are also called malignant cells.
CML causes an uncontrolled growth of immature and mature cells that make a certain type of white blood cell called myeloid cells. The diseased cells build up in the bone marrow and blood.
Causes
Cause of CML is related to an abnormal chromosome called the Philadelphia chromosome.
Radiation exposure can increase the risk of developing CML. Radiation exposure can be from radiation treatments used in the past to treat thyroid cancer or Hodgkin lymphoma or from a nuclear disaster.
It takes many years to develop leukemia from radiation exposure. Most people treated for cancer with radiation do not develop leukemia. And most people with CML have not been exposed to radiation.
CML most often occurs in middle-age adults and in children.
Symptoms
Chronic myelogenous leukemia is grouped into phases:
- Chronic
- Accelerated
- Blast crisis
The chronic phase can last for months or years. The disease may have few or no symptoms during this time. Most people are diagnosed during this stage, when they have blood tests done for other reasons.
The accelerated phase is a more dangerous phase. Leukemia cells grow more quickly. Common symptoms include fever (without infection), bone pain , and a swollen spleen .
Fever
Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...
Bone pain
Bone pain or tenderness is aching or other discomfort in one or more bones.
Swollen spleen
Splenomegaly is a larger-than-normal spleen. The spleen is an organ in the upper left part of the belly.
Untreated CML leads to the blast crisis phase. Bleeding and infection may occur due to bone marrow failure.
Other possible symptoms of a blast crisis include:
- Bruising
-
Excessive sweating
(night sweats)
Excessive sweating
Sweating is the release of liquid from the body's sweat glands. This liquid contains salt. This process is also called perspiration. Sweating helps...
ImageRead Article Now Book Mark Article -
Fatigue
Fatigue
Fatigue is a feeling of weariness, tiredness, or lack of energy.
Read Article Now Book Mark Article - Fever
- Pressure under the lower left ribs from a swollen spleen
-
Rash - small pinpoint red marks on the skin (
petechiae
)
Petechiae
Bleeding into the skin can occur from broken blood vessels that form tiny red dots (called petechiae). Blood also can collect under the tissue in la...
ImageRead Article Now Book Mark Article - Weakness
Exams and Tests
A physical examination often reveals a swollen spleen. A complete blood count ( CBC ) shows an increased number of white blood cells with many immature forms present and an increased number of platelets. These are parts of the blood that help blood clot.
CBC
A complete blood count (CBC) test measures the following:The number of red blood cells (RBC count)The number of white blood cells (WBC count)The tota...
Other tests that may be done include:
-
Bone marrow
biopsy
Bone marrow
Bone marrow is the soft tissue inside bones that helps form blood cells. It is found in the hollow part of most bones. Bone marrow aspiration is th...
ImageRead Article Now Book Mark Article - Blood and bone marrow testing for the presence of the Philadelphia chromosome
-
Platelet count
Platelet count
A platelet count is a lab test to measure how many platelets you have in your blood. Platelets are parts of the blood that help the blood clot. The...
Read Article Now Book Mark Article
Treatment
Medicines that target the abnormal protein made by the Philadelphia chromosome are often the first treatment for CML. These medicines can be taken as pills.
Sometimes, chemotherapy is used first to reduce the white blood cell count if it is very high at diagnosis.
The blast crisis phase is very difficult to treat. This is because there is a very high count of immature white blood cells (leukemia cells).
The only known cure for CML is a bone marrow transplant , or stem cell transplant. Most people, though, do not need a transplant because the targeted medicines are successful. Discuss your options with your oncologist.
Bone marrow transplant
A bone marrow transplant is a procedure to replace damaged or destroyed bone marrow with healthy bone marrow stem cells. Bone marrow is the soft, fat...
You and your health care provider may need to manage many other issues or concerns during your leukemia treatment, including:
-
Managing your pets during chemotherapy
Managing your pets during chemotherapy
People with weakened immune systems may be advised to give up their pets to avoid getting diseases from the animals. People in this category include...
Read Article Now Book Mark Article -
Bleeding problems
Bleeding problems
Cancer treatment - bleeding; Chemotherapy - bleeding; Radiation - bleeding; Bone marrow transplant - bleeding; Thrombocytopenia - cancer treatment...
Read Article Now Book Mark Article -
Eating enough calories when you are sick
Eating enough calories when you are sic
Getting more calories - adults; Chemotherapy - calories; Transplant - calories; Cancer treatment - calories
Read Article Now Book Mark Article -
Swelling and pain in your mouth
Swelling and pain in your mouth
Cancer treatment - mucositis; Cancer treatment - mouth pain; Cancer treatment - mouth sores; Chemotherapy - mucositis; Chemotherapy - mouth pain; Che...
Read Article Now Book Mark Article -
Safe eating during cancer treatment
Safe eating during cancer treatment
Cancer treatment - eating safely; Chemotherapy - eating safely; Immunosuppression - eating safely; Low white blood cell count - eating safely; Neutro...
Read Article Now Book Mark Article
Support Groups
You can ease the stress of illness by joining a cancer support group . Sharing with others who have common experiences and problems can help you not feel alone.
Cancer support group
The following organizations are good resources for information on cancer:American Cancer Society -- www. cancer. orgCancerCare -- www. cancercare. or...
Outlook (Prognosis)
Targeted medicines have greatly improved the outlook for people with CML. When the signs and symptoms of CML go away and blood counts and bone marrow biopsy appear normal, the person is considered in remission. Most people can remain in remission for many years while on this medicine.
Stem cell or bone marrow transplant is often considered in people whose disease comes back or gets worse while taking the initial medicines. Transplant may also be recommended for people who are diagnosed in accelerated phase or blast crisis.
Possible Complications
Blast crisis can lead to complications, including infection, bleeding, fatigue, unexplained fever, and kidney problems. Chemotherapy can have serious side effects, depending on the drugs used.
Prevention
Avoid exposure to radiation when possible.
References
Kantarjian H, Cortes J. Chronic myeloid leukemia. In: Niederhuber JE, Armitage JO, Doroshow JH, et al, eds. Abeloff's Clinical Oncology . 5th ed. Philadelphia, PA: Elsevier; 2014:chap 101.
National Cancer Institute: PDQ chronic myelogenous leukemia treatment. Bethesda, MD: National Cancer Institute. Updated March 9, 2016. www.cancer.gov/cancertopics/pdq/treatment/CML/HealthProfessional . Accessed March 17, 2016.
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: chronic myelogenous leukemia. Version 1.2016. www.nccn.org/professionals/physician_gls/pdf/cml.pdf . Accessed March 17, 2016.
-
Bone marrow aspiration - illustration
A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some storage diseases, in which abnormal metabolic products are stored in certain bone marrow cells.
Bone marrow aspiration
illustration
-
Auer rods - illustration
Note multiple Auer rods which are found only in acute myeloid leukemias, either myeloblastic or monoblastic. These rods consist of clumps of azurophilic granule material.
Auer rods
illustration
-
Chronic myelocytic leukemia - microscopic view - illustration
This high-power microscopic view of a blood smear from a person with classical CML shows predominantly normal-appearing cells with intermediate maturity.
Chronic myelocytic leukemia - microscopic view
illustration
-
Chronic myelocytic leukemia - illustration
Oil immersion field demonstrating myeloid cells of all degrees of maturity.
Chronic myelocytic leukemia
illustration
-
Chronic myelocytic leukemia - illustration
Low power view showing marked hypercellularity with a broad-spectrum of myeloid and erythroid cell types and marked myeloid hyperplasia.
Chronic myelocytic leukemia
illustration
-
Antibodies - illustration
Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.
Antibodies
illustration
-
Bone marrow aspiration - illustration
A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some storage diseases, in which abnormal metabolic products are stored in certain bone marrow cells.
Bone marrow aspiration
illustration
-
Auer rods - illustration
Note multiple Auer rods which are found only in acute myeloid leukemias, either myeloblastic or monoblastic. These rods consist of clumps of azurophilic granule material.
Auer rods
illustration
-
Chronic myelocytic leukemia - microscopic view - illustration
This high-power microscopic view of a blood smear from a person with classical CML shows predominantly normal-appearing cells with intermediate maturity.
Chronic myelocytic leukemia - microscopic view
illustration
-
Chronic myelocytic leukemia - illustration
Oil immersion field demonstrating myeloid cells of all degrees of maturity.
Chronic myelocytic leukemia
illustration
-
Chronic myelocytic leukemia - illustration
Low power view showing marked hypercellularity with a broad-spectrum of myeloid and erythroid cell types and marked myeloid hyperplasia.
Chronic myelocytic leukemia
illustration
-
Antibodies - illustration
Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.
Antibodies
illustration
-
Myeloproliferative disorders
(Alt. Medicine)
Review Date: 2/1/2016
Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
