Leukemia – Chronic Myeloid – CML

Overview

Leukemia is a cancer of the blood. Leukemia begins when normal blood cells change and grow uncontrollably. Chronic myeloid leukemia (CML) is a cancer of the blood-producing cells of the bone marrow (the spongy, red tissue in the inner part of the large bones) that primarily results in an increase in the number of white blood cells (cells that normally fight infection). CML is also sometimes called chronic granulocytic, chronic myelocytic, or chronic myelogenous leukemia. CML makes up about 9% of all new cases of leukemia.

Diagnosis

Doctors use many tests to diagnose cancer and determine more about the disease. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may also be used. Your doctor may consider these factors when choosing a diagnostic test:

• Age and medical condition
• The type of cancer suspected
• Severity of symptoms
• Previous test results

The following tests may be used to diagnose or monitor CML:
Blood tests. Many people are diagnosed with CML before they have any symptoms through a blood test, called a complete blood count (CBC), which counts the number of different kinds of cells in the blood. A CBC is often done as part of a regular physical examination. People with CML have high levels of white blood cells. In advanced stages of CML, there may be low levels of red blood cells (anemia) or either elevated or decreased numbers of platelets.

Treatment

The treatment of CML depends on the phase of the disease and the patient’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan.

Targeted treatments: tyrosine kinase inhibitors
These drugs are a type of targeted therapy, which is treatment that targets faulty genes or proteins that contribute to cancer growth and development. In this case, the target is a specialized protein called the BCR-ABL tyrosine kinase enzyme that is involved in CML.

Imatinib
Imatinib (Gleevec) was approved by the U.S. Food and Drug Administration (FDA) in 2001 for the treatment of all phases of CML. This drug has the unique ability to specifically inhibit the action of the BCR-ABL enzyme, which in turn results in the rapid death of the CML cells. Imatinib may also be used to treat adult acute lymphocytic leukemia (ALL).

Dasatinib
The FDA approved dasatinib (Sprycel) for the treatment of adults with CML and Philadelphia-positive ALL when previous treatment, including imatinib, did not work, stopped working, or could not be given. Dasatinib is a pill that may be taken once or twice a day, depending on the dose.

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