Learn About Chronic Myelogenous Leukemia

What is the definition of Chronic Myelogenous Leukemia (CML)?

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.

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.

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What are the alternative names for Chronic Myelogenous Leukemia (CML)?

CML; Chronic myeloid leukemia; CGL; Chronic granulocytic leukemia; Leukemia - chronic granulocytic

What are the causes of Chronic Myelogenous Leukemia (CML)?

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.

What are the symptoms of Chronic Myelogenous Leukemia (CML)?

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 (even without infection), bone pain, and a swollen spleen.

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)
  • Fatigue
  • Fever
  • Pressure under the lower left ribs from a swollen spleen
  • Rash -- small pinpoint red marks on the skin (petechiae)
  • Weakness
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What are the current treatments for Chronic Myelogenous Leukemia (CML)?

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. People treated with these drugs often go into remission quickly and can stay in remission for many years.

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) that are resistant to treatment.

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.

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What are the support groups for Chronic Myelogenous Leukemia (CML)?

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.

What is the outlook (prognosis) for Chronic Myelogenous Leukemia (CML)?

Targeted medicines have greatly improved the outlook for people with CML. Most people can remain in remission, assessed typically by blood tests, 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.

What are the possible complications of Chronic Myelogenous Leukemia (CML)?

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.

How do I prevent Chronic Myelogenous Leukemia (CML)?

Avoid exposure to radiation when possible.

Bone marrow aspiration
Chronic myelocytic leukemia - microscopic view
Chronic myelocytic leukemia
Chronic myelocytic leukemia
What are the latest Chronic Myelogenous Leukemia Clinical Trials?
Graft-versus-host Disease Prophylaxis With Combination of Post-transplantation Benadamustine and Cyclophosphamide in Patients With Refractory Myeloid Malignancies (PTBCy)
Summary: Prognosis of patients undergoing salvage allogeneic stem cell transplantation for refractory leukemia or other refractory myeloid malignanies is poor. One of the approaches to augment graft-versus-leukemia effect the use of post-transplantation bendamustine in graft-versus-host disease prophylaxis. Despite high frequency of responses and durable remissions after this approach majority of patients ...
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Expression of TIGIT in NK Cells in Patients With Chronic Myeloid Leukemia
Summary: To expresse TIGIT in NK Cells in Patients with Chronic Myeloid Leukemia
What are the Latest Advances for Chronic Myelogenous Leukemia?
Olverembatinib (HQP1351), a well-tolerated and effective tyrosine kinase inhibitor for patients with T315I-mutated chronic myeloid leukemia: results of an open-label, multicenter phase 1/2 trial.
Summary: Olverembatinib (HQP1351), a well-tolerated and effective tyrosine kinase inhibitor for patients with T315I-mutated chronic myeloid leukemia: results of an open-label, multicenter phase 1/2 trial.
Bosutinib versus imatinib for newly diagnosed chronic phase chronic myeloid leukemia: final results from the BFORE trial.
Summary: Bosutinib versus imatinib for newly diagnosed chronic phase chronic myeloid leukemia: final results from the BFORE trial.
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Management of chronic myeloid leukemia in myeloid blastic phase with novel therapies: a systematic literature review.
Summary: Management of chronic myeloid leukemia in myeloid blastic phase with novel therapies: a systematic literature review.
Who are the sources who wrote this article ?

Published Date: January 25, 2022
Published 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, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Kantarjian H, Cortes J. Chronic myeloid leukemia. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 98.

National Cancer Institute website. Chronic myelogenous leukemia treatment (PDQ) health professional version. www.cancer.gov/types/leukemia/hp/cml-treatment-pdq. Updated January 21, 2022. Accessed June 7, 2022.

National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology: (NCCN guidelines).Chronic myeloid leukemia. Version 1.2023. www.nccn.org/professionals/physician_gls/pdf/cml.pdf. Updated August 5, 2022. Accessed August 10. 2022.

Radich J. Chronic myeloid leukemia. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 175.