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Chronic myelogenous leukemia


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is chronic myelogenous leukemia?
STAGE EXPLANATION
Stages of chronic myelogenous leukemia
Chronic phase
Accelerated phase
Blastic phase
Refractory
TREATMENT OPTION OVERVIEW
How chronic myelogenous leukemia is treated
Treatment by stage
CHRONIC PHASE CHRONIC MYELOGENOUS LEUKEMIA
ACCELERATED PHASE CHRONIC MYELOGENOUS LEUKEMIA
BLASTIC PHASE CHRONIC MYELOGENOUS LEUKEMIA
MENINGEAL CHRONIC MYELOGENOUS LEUKEMIA
REFRACTORY CHRONIC MYELOGENOUS LEUKEMIA
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is chronic myelogenous leukemia?

Chronic myelogenous leukemia (also called CML or chronic granulocytic leukemia) is a disease in which too many white blood cells are made in the bone marrow. The bone marrow is the spongy tissue inside the large bones in the body. The bone marrow makes red blood cells (which carry oxygen and other materials to all tissues of the body), white blood cells (which fight infection), and platelets (which make the blood clot).

Normally, bone marrow cells called blasts develop (mature) into several different types of blood cells that have specific jobs to do in the body. CML affects the blasts that are developing into white blood cells called granulocytes. The blasts do not mature and become too numerous. These immature blast cells are then found in the blood and the bone marrow. In most people with CML, the genetic material (chromosomes) in the leukemia cells have a feature that is not normal called a Philadelphia chromosome. This chromosome usually doesn't go away, even after treatment.

Leukemia can be acute (progressing quickly with many immature blasts) or chronic (progressing slowly with more mature-looking cancer cells). Chronic myelogenous leukemia progresses slowly and usually occurs in people who are middle-aged or older, although it also can occur in children. In the first stages of CML, most people don't have any symptoms of cancer. A doctor should be seen if any of the following symptoms appear: tiredness that won't go away, a feeling of no energy, fever, not feeling hungry, or night sweats. Also, the spleen (the organ in the upper abdomen that makes other types of white blood cells and filters old blood cells from the blood) may be swollen.

If there are symptoms, a doctor may order blood tests to count the number of each of the different kinds of blood cells. If the results of the blood test are not normal, the doctor may order more blood tests. A bone marrow biopsy also may be done. During this test, a needle is inserted into a bone and a small amount of bone marrow is taken out and looked at under the microscope. The doctor can then tell what kind of leukemia the patient has and plan the best treatment.

Separate statements containing patient information on acute lymphocytic leukemia (adult and childhood), acute myeloid leukemia (adult and childhood), and hairy cell leukemia are also available in PDQ.


STAGE EXPLANATION


Stages of chronic myelogenous leukemia

Once chronic myelogenous leukemia (CML) has been found (diagnosed), more tests may be done to find out if leukemia cells have spread into other parts of the body such as the brain. This is called staging. CML progresses through 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 fewer normal cells.


Blastic phase

More than 30% of the cells in the blood or bone marrow are blast cells. The blast phase of CML is sometimes called "blast crisis." Sometimes blast cells will form tumors outside of the bone marrow in places such as the bone or lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. They produce and store infection-fighting cells.


Refractory

Leukemia cells do not decrease even though treatment is given.


TREATMENT OPTION OVERVIEW


How chronic myelogenous leukemia is treated

There are treatments for all patients with chronic myelogenous leukemia. Three kinds of treatment are used:

chemotherapy (using drugs to kill cancer cells)
radiation therapy (using high-dose x-rays or other high-energy rays to kill
cancer cells)
bone marrow transplantation (killing the bone marrow and replacing it
with healthy marrow).

The use of biological therapy (using the body's immune system to fight cancer) is being tested in clinical trials. Surgery may be used in certain cases to relieve symptoms.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. Chemotherapy also can be put directly into the fluid around the brain and spinal cord through a tube inserted into the brain or back. This is called intrathecal chemotherapy.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation for CML usually comes from a machine outside the body (external radiation therapy) and is sometimes used to relieve symptoms or as part of therapy given before a bone marrow transplant.

Bone marrow transplantation is used to replace the patient's bone marrow with healthy bone marrow. First, all of the bone marrow in the body is destroyed with high doses of chemotherapy with or without radiation therapy. Healthy marrow is then taken from another person (a donor) whose tissue is the same as or almost the same as the patient's. The donor may be a twin (the best match), a brother or sister, or another person not related. The healthy marrow from the donor is given to the patient through a needle in the vein, and the marrow replaces the marrow that was destroyed. A bone marrow transplant using marrow from a relative or person not related to the patient is called an 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 is taken from the patient and treated with drugs to kill any cancer cells. The marrow is then frozen to save it. The patient is given high-dose chemotherapy with or without radiation therapy to destroy all of the remaining marrow. The frozen marrow that was saved is then thawed and given back to the patient through a needle in a vein to replace the marrow that was destroyed.

A greater chance for recovery occurs if a doctor chooses a hospital which does more than 5 bone marrow transplantations per year.

Biological therapy tries to get the body to fight cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

If the spleen is swollen, a doctor may take out the spleen in an operation called a splenectomy.


Treatment by stage

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Most patients are not cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are on going in most parts of the country for patients with CML of any phase. To know more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


CHRONIC PHASE CHRONIC MYELOGENOUS LEUKEMIA

Treatment may be one of the following:

1. High-dose chemotherapy with radiation therapy followed by bone marrow transplantation.

2. Biological therapy.

3. Chemotherapy to lower the number of white blood cells.

4. Surgery to remove the spleen (splenectomy).

5. Chemotherapy and/or radiation therapy followed by bone marrow transplantation.


ACCELERATED PHASE CHRONIC MYELOGENOUS LEUKEMIA

Treatment may be one of the following:

1. Bone marrow transplantation.

2. Biologic therapy.

3. High-dose chemotherapy.

4. Chemotherapy to lower the number of white blood cells.

5. Other chemotherapy drugs.

6. Transfusions of blood or blood products to relieve symptoms.


BLASTIC PHASE CHRONIC MYELOGENOUS LEUKEMIA

Treatment may be one of the following:
1. A clinical trial evaluating new chemotherapy drugs and/or new combinations of drugs.

2. Chemotherapy.

3. Bone marrow transplantation.

4. Chemotherapy to relieve symptoms associated with the cancer.

5. Radiation therapy to relieve symptoms caused by tumors formed in the bone.

6. High-dose chemotherapy.


MENINGEAL CHRONIC MYELOGENOUS LEUKEMIA

Treatment may be one of the following:

1. Chemotherapy injected into the spinal canal.

2. Other chemotherapy drugs injected into the spinal canal.

3. Radiation therapy to the brain.


REFRACTORY CHRONIC MYELOGENOUS LEUKEMIA

The treatment depends on many factors. A patient may wish to consider entering a clinical trial. If the patient has had a bone marrow transplant, the treatment may be biological therapy or white blood cells from the bone marrow donor may be given to the patient through a vein.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about chronic myelogenous leukemia, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, trained information specialists can answer your questions.

The Cancer Information Service also has booklets about cancer that are available to the public and can be sent on request. The following booklets about leukemia may be helpful:

What You Need To Know About Leukemia
Research Report: Bone Marrow Transplantation

The following general booklets on questions related to cancer may also be helpful:

Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
What You Need To Know About Cancer
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again

There are many other places where people can get material and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 05/1999


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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