October 25, 2009

Chronic Myeloid Leukemia(CML)

Chronic myeloid leukemia is a cancer of the blood system in which too many white blood cells (WBCs) are made in the bone marrow.

What is CML ?

MOLECULAR BASIS •Leukemic white blood cells in CML

contain a Philadelphia (Ph) chromosome.

•The Ph chromosome is the result of a translocation between the long arms of chromosomes 9 and 22.

This exchange brings together two genes:

The BCR gene on chromosome 22 and the proto-oncogene ABL

on chromosome 9.

CML

Fatigue

Weight Loss

Swelling of the spleen

Bruising

Because many people with early CML have no symptoms, about half of CML

cases are detected when a person visits a doctor for a routine checkup or blood

test.

Signs and

Symptoms

Blood Test

Bone Marrow Test

Blood cell counts. With CML, the red cell count is lower than normal. The number of white cells is higher than normal and may be very high.

Blood cell examination. A person with CML has a small number of developing cells called "blast cells" in his or her blood. Blast cells are not found in the blood of healthy individuals.

CML DIAGNOSIS

Samples of marrow cells are examined under a microscope. This is called a cytogenetic analysis. The examiner looks at a map of the chromosomes in the cell. The map is called a "karyotype." The Ph chromosome in a CML cell can be detected on the karyotype.

•There are mostly mature leukemia WBCs in the blood and bone marrow and there may be no symptoms of leukemia.

Chronicaverage duration

of 5 to 6 years

•There are some immature leukemia WBCs in the blood and bone marrow (between 5 percent and 30 percent). Patients may have fever, poor appetite and weight loss.

Acceleratedaverage duration of

6 to 9 months

•In this phase, there are mostly immature WBCs in the blood and bone marrow . Symptoms such as anemia and recurring infections are typical.

BlastAverage duration of 3 to 6 months

Phases of CML

TREATMENTS

Chemotherapy

• Bone marrow transplantation

• Removal of the spleen

• The newest treatment is Gleevec®, a therapy that is believed to interfere with the action of the abnormalities in CML white blood cells.

WHO GETS CML?The American Cancer Society

estimates that in 2007 there will be about 4,570 new cases of chronic myelogenous leukemia in the United States.

With the average age of people with CML around 66 years, CML mostly affects adults

2 percent of CML patients are children.

Survival Rates by Treatment

•Abeloff, D.A., Armitage, J.O., Niederhuber, J.E., Kastan, M.B., & McKenna, W.G. (2004). Abeloff: Clinical Oncology, 3rd ed. New, York: Elsevier Churchill. http://www.leukemia-lymphoma.org/all_page?item_id=8501#

• National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology: Chronic myelogenous leukemia. Version 2, 2009. www.nccn.org/professionals/physician_gls/default.asp

• Pui, C.-H., & Evans, W.E. (2006). Treatment of acute lymphoblastic leukemia. The New England Journal of Medicine, 354, 166-178.

• Society of Spectacle. Dir. Guy Debord. 1973. Online video clip. Gleevec.com. 09 October 2007. http://www.ubu.com/film/debord_spectacle.html

Bibliography