Chronic myelogenous leukemia (CML)
CML; Chronic myeloid leukemia; CGL; Chronic granulocytic leukemia; Leukemia - chronic granulocyticChronic myelogenous leukemia (CML) is cancer that starts inside the bone marrow. This is the soft tissue in the center of bones that helps form all blood cells.
Cancer
Cancer is the uncontrolled growth of abnormal cells in the body. Cancerous cells are also called malignant 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.
Causes
The 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.
Symptoms
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.
Fever
Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...
Bone pain
Bone pain or tenderness is aching or other discomfort in one or more bones.
Swollen spleen
Splenomegaly is a larger-than-normal spleen. The spleen is an organ in the upper left part of the belly.
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
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Excessive sweating (night sweats)
Excessive sweating
Sweating is the release of liquid from the body's sweat glands. This liquid contains salt. This process is also called perspiration. Sweating helps...
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Fatigue
Fatigue
Fatigue is a feeling of weariness, tiredness, or lack of energy.
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- Pressure under the lower left ribs from a swollen spleen
- Rash -- small pinpoint red marks on the skin (petechiae)
Petechiae
Bleeding into the skin can occur from broken blood vessels that form tiny red dots (called petechiae). Blood also can collect under the tissue in la...
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Exams and Tests
A physical examination often reveals a swollen spleen. A complete blood count (CBC) shows an increased number of white blood cells with many immature forms present and an increased number of platelets. These are parts of the blood that help blood clot.
CBC
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...
Other tests that may be done include:
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Bone marrow biopsy
Bone marrow
Bone marrow is the soft tissue inside bones that helps form blood cells. It is found in the hollow part of most bones. Bone marrow aspiration is th...
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Treatment
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.
Chemotherapy
The term chemotherapy is used to describe cancer-killing drugs. Chemotherapy may be used to:Cure the cancerShrink the cancerPrevent the cancer from ...
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.
Support Groups
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.
Cancer support group
The following organizations are good resources for information on cancer:American Cancer Society. Support and online communities. www. cancer. org/...
Outlook (Prognosis)
Targeted medicines, such as tyrosine kinase inhibitors, have greatly improved the outlook for people with CML. Most people can remain in remission, assessed typically by blood tests, for many years, and potentially for life, 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 medicines. Transplant may also be recommended for people who are diagnosed in accelerated phase or blast crisis.
Possible Complications
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.
Prevention
Avoid exposure to radiation when possible.
References
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 April 19, 2024. Accessed May 7, 2024.
National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology: (NCCN guidelines).Chronic myeloid leukemia. Version 2. 2024. www.nccn.org/professionals/physician_gls/pdf/cml.pdf. Updated December 5, 2023. Accessed May 7, 2024.
Radich J. Chronic myeloid leukemia. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 170.
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Bone marrow aspiration - illustration
A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some storage diseases, in which abnormal metabolic products are stored in certain bone marrow cells.
Bone marrow aspiration
illustration
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Chronic myelocytic leukemia - microscopic view - illustration
This high-power microscopic view of a blood smear from a person with classical CML shows predominantly normal-appearing cells with intermediate maturity.
Chronic myelocytic leukemia - microscopic view
illustration
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Chronic myelocytic leukemia - illustration
Oil immersion field demonstrating myeloid cells of all degrees of maturity.
Chronic myelocytic leukemia
illustration
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Chronic myelocytic leukemia - illustration
Low power view showing marked hypercellularity with a broad-spectrum of myeloid and erythroid cell types and marked myeloid hyperplasia.
Chronic myelocytic leukemia
illustration
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Bone marrow aspiration - illustration
A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some storage diseases, in which abnormal metabolic products are stored in certain bone marrow cells.
Bone marrow aspiration
illustration
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Chronic myelocytic leukemia - microscopic view - illustration
This high-power microscopic view of a blood smear from a person with classical CML shows predominantly normal-appearing cells with intermediate maturity.
Chronic myelocytic leukemia - microscopic view
illustration
-
Chronic myelocytic leukemia - illustration
Oil immersion field demonstrating myeloid cells of all degrees of maturity.
Chronic myelocytic leukemia
illustration
-
Chronic myelocytic leukemia - illustration
Low power view showing marked hypercellularity with a broad-spectrum of myeloid and erythroid cell types and marked myeloid hyperplasia.
Chronic myelocytic leukemia
illustration
Review Date: 3/31/2024
Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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