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is CML?


Leukemia is a cancer that occurs in blood effecting
mainly white blood cells “liquid cancer”.it is caused by a group of malignancy factors

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Such as genetic mutations. In Chronic myeloid leukemia malignancy factors affect the myeloid cells line
(neutrophil, basophil, eosinophil) when
the bone marrow have no control on the hematopoiesis process leading to
accumulation of all mature myeloid cells and blasts because of overproduction
and release of immature cells, especially blast cells to the peripheral blood
as a mature cell.


How does the CML occur?

In most cases about
95% it occurs by genetic disorder mainly when a chromosome called
“Philadelphian chromosome” is formed, in male more than female. Philadelphian
chromosome is a genetic mutation that occurs by genetic translocation between
chromosome 22 and chromosome 9. Genetically, it’s called as a fusion gene.
Moreover, another risk factors can highly contribute increase the incidence of
CML such as exposure to radiations, some chemical drugs, reagents such as
benzene, and aging.


Signs and symptoms:

Approximately 25% of
people affected with CML show no symptoms, however they gradually get worse
when they occur. Symptoms include having infection more often, weight loss, swelling
lymph glands, Splenomegaly, Hepatomegaly, bleeding,
and poor appetite.


How we diagnose the CML?

It is mainly detected
by Complete Blood Count (CBC). It will show an increased mature granulocytes
especially increased basophil and eosinophil, which is known as eosinophilia
and basophilia, in addition to decreased RBCs level which leads to anemia with
few nucleated RBCs, type of anemia Normocytic normochromic anemia. Also,
thrombocytosis (high production of platelets) is found in most cases. With all of
the above features, we will be able to differentiate between the CML from Leukemoid reaction.Another method of
diagnosis is a biopsy of the bone marrow and examination of the sample, reveling
hypercellular in granucytes with presence of blasts and reduce in erythroid.Third
method, by the cytogenetic reactions, which detects the presence of
Philadelphian chromosome, by the chromosomal translocation t(9;22). Forth
method is by molecular techniques which detect and check genetic abnormalities.



CML has 3 phases:

–       Chronic phase, where most of patients (90%) are diagnosed, and could
be symptomatic and asymptomatic.

–       Accelerated phase, where patients got increase WBCs level and bone
marrow failure is also shown.

–       Blastic phase, when it follows acute leukemia’s way. multiple organ
failure occurs.



Management and Treatment:


Chemotherapy is a treatment that is made by
several medications. It’s the most active treatment used for leukemia patients,
which reduces the blast and over presence of white blood cells in peripheral blood
and thus, will give the patient a long-time survival.


Stem Cell Transplantation, by 2 main ways:


Autologous transplantation: Stem cells from the patient’s
body, after the doctor treats them by powerful chemotherapy.


–       Allogeneic
Transplantation: Whereas patient get stem cells from another person.

Interferon alpha: is a treatment of choice for people
who can’t go through BMT.

Splenectomy is performed for patients with
painful, large spleens.

Medications are used to delay the onset of accelerated
and blastic phase. Some medications could be combined with another treatment

Antineoplastic Agents  to
control hyperproliferation of the myeloid elements

Interferons to inhibit proliferation of Ph-positive
hematopoietic clone. Interferon
alpha is a treatment of choice for people who can’t go through BMT

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