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Chronic Myelogenous Leukemia Diangosis and Treatment

Chronic myeloid leukemia Evolution 

 

Proper  chronic myeloid leukemia treatment is required; otherwise, the disease evolves naturally into three phases:
Chronic phase: during this phase, leukemia progresses slowly. In the absence of treatment, this phase lasts in average four years. The cancer can be completely asymptomatic. Over 90% of patients are diagnosed in the chronic phase.
Acceleration phase: this corresponds to an increase in the proportion of abnormal white blood cells in the blood and in the bone marrow, which eventually leads to an abnormal bone marrow functions, causing
 fever (without infection), bone pain, and a swollen spleen. If a proper treatment is not implemented, the disease progresses after several months towards the acute phase.
Acute or
 Blast Crisis phase: chronic or accelerated leukemia becomes acute (or blast). The bone marrow is invaded by the very young abnormal white blood cells called blasts, and may not function properly. At this phase, patients tend to experience the following  symptoms: 

  • Fever  
  • Fatigue  
  • Bruising  
  • Weakness   
  • Excessive sweating (mostly at night)  
  • Pressure under the lower left ribs from a swollen spleen  
  • Rash - small pinpoint red marks on the skin (petechiae).  

Chronic Myeloid Leukemia Treatment

With the advancement in medical research,
 chronic myeloid leukemia treatment provides better results in terms of survival and healing. In recent years, the treatment of chronic myeloid leukemia has experienced some great advancement, mainly with the use of targeted therapy, a therapy that allows the drugs acting on the signals responsible for the uncontrolled growth of cancer cells. 


In chronic
 myeloid leukemia, these drugs target the diseased cells carrying the Philadelphia chromosome and bcr-abl gene. They help to prevent the development of chronic myeloid leukemia. In fact, these drugs are usually the first treatment options considered by most oncologists to fight chronic myeloid leukemia. It has been several years since imatinib (Gleevec ®) has revolutionized the treatment of CML.

Two other molecules are also available and reinforce the therapeutic properties of the other medications: Nilotinib (Tasigna ) and dasatinib (Sprycel ®).  To combat some resistance and / or intolerance that some patients experience, the pharmaceutical industry is working to develop new molecules.  


It is necessary to undergo chronic
 myeloid leukemia treatment as recommended, and report all serious side effects to the health care provider. Common serious side effects caused my medications used in chronic myeloid leukemia treatment include: 

  • Irregular heart rhythm  
  • Fainting  
  • Stomach pain or swelling  
  • Bloody vomit   
  • Difficulty breathing   
  • Loss of consciousness  
  • Seizures  
  • Possibly sudden death  

Monitoring  after Treatment 

 

Chronic  myeloid leukemia patients need to be monitored by an oncologist or a specialist in blood diseases (hematologist) during and after the treatment. The monitoring can be scheduled on a weekly basis at first, then every month, then every 3 months during the first 2 years of treatment, and hopefully every 4 to 6 months.  

 

These consultations are fundamental to assess the tolerance of the treatment and measure its effectiveness. Regular visits also help the health care provider to perform different blood tests and regular monitoring of the effectiveness of the treatment on the bone marrow. This can require bone marrow aspiration and analysis of chromosomes as well measuring bcr-abl gene. Controlling drug concentration in the blood may be necessary to ensure the right dosage to prevent overdose and its fetal consequence. 


 

Chronic Myeloid Leukemia Symptoms

  

References:  

1.    Besa, EC; Buehler, B; Markman, M; Sacher, RA (27 December 2013). Krishnan, K, ed. "Chronic Myelogenous Leukemia". Medscape Reference. WebMD. Retrieved 3 January 2014. 

2.    Besa, EC; Buehler, B; Markman, M; Sacher, RA (27 December 2013). Krishnan, K, ed. "Chronic Myelogenous Leukemia Clinical Presentation". Medscape Reference. WebMD. Retrieved 3 January 2014. 

3.    Provan, D; Gribben, JG (2010). "Chapter 7 Chronic myelogenous leukemia". Molecular Hematology (3rd ed.). Singapore: Wiley-Blackwell. p. 76. ISBN 9781444318548

4.    Kufe DW; Pollack RE; Weichselbau RR et al., eds. (2003). "Tyrosine Kinase Inhibitors: Targeting Considerations". Holland-Frei Cancer Medicine (NCBI bookshelf book) (6th ed.). Hamilton, Ontario: BC Decker. ISBN 1-55009-213-8. Retrieved October 27, 2012  

5.    Besa, EC; Buehler, B; Markman, M; Sacher, RA (27 December 2013). Krishnan, K, ed. "Chronic Myelogenous Leukemia". Medscape Reference. WebMD. Retrieved 3 January 2014. 

6.    Jabbour, E.; Cortes, J. E.; Giles, F. J.; O'Brien, S.; Kantarjian, H. M. (2007). "Current and emerging treatment options in chronic myeloid leukemia". Cancer 109 (11): 2171–2181. doi:10.1002/cncr.22661. 

7.    Kantarjian H, Cortes J. Chronic myeloid leukemia. In: Niederhuber JE, Armitage JO, Doroshow JH, et al., eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2013:chap 101. 

8.    National Cancer Institute: PDQ Chronic Myelogenous Leukemia Treatment. Bethesda, Md: National Cancer Institute. Date last modified: Nov. 18, 2013. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/CML/HealthProfessional. Accessed: March 23, 2014. 

9.    Sokal J, Baccarani M, Russo D, Tura S (1988). "Staging and prognosis in chronic myelogenous leukemia". Semin Hematol 25 (1): 49–61. PMID 3279515. 

10. Chronic myeloid leukaemia (CML) statistics". Cancer Research UK. Retrieved 28 October2014.b