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Introduction |
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| What
is Chronic Myeloid Leukemia: |
| Chronic myeloid leukemia
is a cancer of blood cells in which the bone marrow makes
too many white cells. Chronic myeloid leukemia (also called
CML) is a slowly progressing blood and bone marrow disease
that usually occurs during or after middle age, and rarely
occurs in children. This cancer starts in the bone marrow
and can then spread to the blood, lymph nodes, spleen,
liver, central nervous system and other organs. |
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| What are the types of blood cells: |
| There are 3 types of
mature blood cells: |
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Red blood cells that carry oxygen and other materials
to all tissues of the body. |
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White blood cells that fight
infection and disease. |
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Platelets that help prevent
bleeding by causing blood clots to form. |
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| In CML, too many bone
marrow stem cells develop into a type of white blood cell
called granulocytes. Some of these bone marrow stem cells
never become mature white blood cells. These are called
blast cells. Over time, the granulocytes and blast cells
crowd out the red blood cells and platelets in the bone
marrow. |
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| What are the symptoms of CML: |
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| Symptoms of chronic
myeloid leukemia include tiredness, night sweats, and fever.
These and other symptoms may be caused by CML or by other
conditions. A doctor should be consulted if any of the
following problems occur: |
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| Other symptoms may include: |
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Occasional fever |
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Easily tired, lack of energy,
weakness |
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Loss of appetite |
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Shortness of breath with activity |
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Left sided abdominal pain with
an enlarged spleen |
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Excessive sweating |
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Unusual weight loss |
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Intolerance to warm temperatures |
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Petechiae (Small purple, reddish
spots under the skin) |
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Pale skin secondary to anemia
(decreased red blood cells) |
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Bone and joint pain |
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Bleeding gums |
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Enlarged lymph nodes |
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Sometimes CML does not cause
any symptoms at all. |
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| What your doctor can do: |
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Diagnose the disease by asking
about your symptoms, performing a physical exam, and
ordering laboratory blood tests (tests to measure blood
cell counts and the presence of the Philadelphia chromosome). |
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Check for swelling in body organs
such as the liver, spleen, and in the lymph nodes under
the arm, groin and neck. |
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Order a bone marrow biopsy or
aspiration (inserting a needle to remove a small sample
of bone and/or liquid bone marrow); a spinal tap (checks
cerebrospinal fluid for presence of leukemia cells);
and a chest X-ray. |
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Prescribe antibiotics to fight
infections and anti-nausea medicines to control treatment
side effects. |
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Recommend treatment for CML. |
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| Philadelphia Chromosome: |
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| Every cell in the body
contains genetic material (DNA), that determines how the
cell looks and acts. DNA is contained inside chromosomes.
In CML, part of the DNA from one-chromosome moves to another
chromosome. This change is called the “Philadelphia
chromosome.” It results in the bone marrow making
an enzyme, called tyrosine kinase, that causes too many
stem cells to develop into white blood cells (granulocytes
or blasts). |
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| The Philadelphia chromosome
is not passed from parent to child. |
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| How CML is diagnosed: |
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| Physical examination: An examination of the body to check general signs of health,
including checking for signs of disease such as an enlarged
spleen. |
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| Medical history: A medical
history of the patient’s past illnesses and treatments
is also taken. |
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| Complete blood count: The blood sample is checked for the following: |
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The number of red blood cells,
white blood cells, and platelets. |
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The amount of hemoglobin (the
protein that carries oxygen) in the red blood cells. |
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| Blood chemistry study: A sample of blood is examined to measure the amounts of
certain substances released into the blood by organs and
tissues in the body. An abnormal amount of a substance
can be a sign of disease in the organ or tissue that produces
it. |
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| Cytogenetic analysis: A procedure in which the cells in a sample of blood are
looked at for Philadelphia chromosome. |
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| Bone marrow biopsy
and aspiration: The removal of a small piece of bone and bone
marrow by inserting a needle into the hipbone or breastbone.
A pathologist views the sample under a microscope to look
for abnormal cells. |
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| The treatment options
and prognosis (chance of recovery) depend on the patient’s
age, phase of CML, amount of blasts in the blood or bone
marrow, size of the spleen at diagnosis, and the patient’s
general health. |
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| Phases
of Chronic Myeloid Leukemia |
| Chronic myeloid leukemia
has 3 phases. |
| a. |
Chronic phase |
| b. |
Accelerated phase |
| c. |
Blastic phase |
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| After chronic myeloid
leukemia has been diagnosed, tests are done to find out
if the cancer has spread. The disease is classified by
phase: chronic phase, accelerated phase, or blastic phase.
It is important to know the phase in order to plan the
best treatment. As the amount of blast cells increases
in the blood and bone marrow, there is less room for healthy
white blood cells, red blood cells, and platelets. This
may result in infections, anemia, and easy bleeding, as
well as bone pain and pain or fullness below the ribs on
the left side. The amount of blast cells in the blood and
bone marrow and the severity of symptoms determine the
phase of the disease. |
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| Treatment Options: |
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| Treatment based on the
phase of CML: |
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Chemotherapy: Anti-Cancer
medications like Interferon Alfa, Ara-C, hydroxyurea,
busulfan and Imatinib |
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Radiation: Using high doses
of X-rays to destroy abnormal cells |
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Bone Marrow Transplantation: Destroying abnormal bone marrow with radiation or chemotherapy
and replacing it with donor or patients own bone marrow |
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Surgery: removal of spleen |
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Blood and/or blood product transfusions |
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| Chemotherapy is a cancer
treatment that uses drugs to stop the growth of cancer
cells, either by killing the cells or by stopping the cells
from dividing. Because some normal cells such as blood
and hair can be affected, side effects can occur. Hydroxyurea,
busulfan and cytosine arabinoside are the commonly used
drugs in CML. Their uses are limited due to availability
of safer and more effective newer drug options. |
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| Imatinib is a new type
of cancer drug, called a tyrosine kinase inhibitor. It
blocks the enzyme, tyrosine kinase that causes stem cells
to develop into more white blood cells (granulocytes or
blasts) than the body needs. Imatinib has shown higher
efficacy and safety in-patients with all phases of CML. |
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| Substances made by the
body or made in a laboratory are used to boost, direct,
or restore the body’s natural defenses against cancer.
Interferons are proteins that are produced naturally in
our body in response to certain infections. A type of Interferon,
Interferon alfa helps the body immune system to slow the
growth of cancer cells. The side effects of interferon
therapy include muscle aches, bone pain, headaches, tiredness,
chills, fever, disorientation and sometimes-serious neurological
problems. |
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| High-dose chemotherapy
with stem cell transplantation is a method of giving very
high doses of chemotherapy and replacing blood-forming
cells destroyed by the cancer treatment. Stem cells (immature
blood cells) are removed from the blood or bone marrow
of the patient or a donor and are frozen for storage. After
the chemotherapy is completed, the stored stem cells are
thawed and given back to the patient through an infusion.
Over a short time, these reinfused stem cells grow into
(and restore) the body’s blood cells. |
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| Splenectomy is surgery
to remove the spleen in patients with CML. |
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| What
you can do: |
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See your doctor
regularly to evaluate treatment with physical exams
and periodic blood tests. ent. |
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Talk to your doctor about a
well balanced diet including adequate protein sources. |
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Take your anti-cancer medications
as directed by your doctor. Report any unusual or persistent
side effects to your doctor as soon as possible. |
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Since most anti-cancer medications
lower your resistance to infections, avoid crowded
areas and people with colds or other infections. |
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Protect yourself from cuts or
other injuries. Bleeding is increased with leukemia
and anti-cancer medications. |
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Perform good dental care and
see your dentist regularly. Leukemia and chemotherapy
may increase and worsen bleeding as well as dental
infections. |
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Join a support group to share
information and emotional support. |
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| What you can expect: |
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Early detection and treatment
makes a significant difference in remission (no evidence
of disease after treatment), cure and survival rates. |
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Complications may include a
relapse (return of cancer) and metastasis (spreading
of cancer) to other organs and tissues. |
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New drug therapies have increased
remission rates and now offer alternative treatments
to bone marrow transplants. |
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