Chronic Myeloid Leukaemia

In my spare time I like to write and in the past I haven’t been very successful in continuing stories and I think that is because I didn’t do enough planning to sustain a good story line. Therefore, this time I have decided to change that; my current story is based around a boy with Chronic Myeloid Leukaemia and I did my research on this illness and thought I might as well share my research with everyone.

Chronic Myeloid Leukaemia (CML) is a cancer of the white blood cells in the bone marrow. It is when there is an increase of white blood cells which accumulate in the blood therefore interfering with the production of healthy blood cells which are needed to fight infection. Eventually the body doesn’t have enough red blood cells to supply oxygen, enough platelets to ensure proper clotting or enough normal white blood cells to fight infection making people susceptible to bruising, bleeding and infection. The word ‘chronic’, when talking about leukaemia, means that it develops and progresses more slowly (over months or years even without treatment).

chromosome9and22CML develops due to a problem with a stem cell in the bone marrow which becomes abnormal. Every person has 23 pairs of chromosomes and CML occurs when a piece of chromosome 22 breaks off and switches places with a piece of chromosome 9. The piece containing both parts is known as the Philadelphia Chromosome which results in the cancer gene BCR-ABL; this is what instructs the body to make too many white blood cells.

philadelphia chromosome

The ultimate cause of CML is unknown and although it is caused by an abnormal gene, the disease is not inherited.

Symptoms

Ususally patients with Chronic Myeloid Leukaemia are asymptomatic (present with no symptoms) and are diagnosed after a routine blood test but some symptoms may include:

  • enlarged spleen causing pain on left side (due to the fact that cancerous cells can also develop here as white blood cells are produced there)
  • malaise (a feeling of general discomfort)
  • low grade fever
  • bone and joint pain
  • easy bruising
  • recurrent infections (bronchitis/tonsillitis)
  • anaemia

There are three stages of CML and the further down you go, the more CML becomes more like AML (Acute Myeloid Leukaemia).

Chronic Phase

This is the first stage of CML which usually lasts between 4-5 years and 85% of people are diagnosed within this phase. In the chronic phase there are 5% or fewer blast cells in the blood and bone marrow.

Pills can be taken to control the symptoms (imatinib) and it usually has a good response from patients but if it doesn’t, there are other drugs that people can take such as dasatinib and nilotinib.

If no treatment is taken or if the drugs did not work then the disease progresses to the accelerated phase.

Accelerated Phase

This phase usually lasts between 6-24 months.

In this phase, the number of abnormal cells in the bone marrow and bloodstream builds up. Many of the abnormal cells are ‘blast’ (immature) white blood cells and there are 6-30% blast cells in the blood and bone marrow.As these abnormal cells build up, it is hard for normal cells to develop and grow in the bone marrow to make enough normal blood cells. This causes other problems to occur:

  • Anaemia (due to the lack of red blood cells)- can cause tiredness, breathlessness and may look pale.
  • Blood-clotting problems (due to the low number of platelets)- can cause easy bruising, bleeding from the gums and other bleeding-related problems.
  • Serious infections (reduced number of normal white blood cells and abnormal white blood cells do not protect from infection)
  • Other symptoms may also include weight loss and pain due to enlarged spleen

Sometimes the chronic phase can skip the accelerated phase and may go straight to the third phase (blast phase).

Blast Phase

In this phase, the CML acts a lot more like Acute Myeloid Leukaemia (AML) as it rapidly gets worse. The symptoms above would worsen in this phase due to immature cells developing and filling the bone marrow and spilling into the bloodstream. There is a shorter survival rate for patients who have progressed to this stage.

The prognosis for this disease depends upon the overall health and age of the patient and how advanced the disease was. Only 1% of patients have died because of the progression of the leukaemia.

These are the sites I used for my research:

http://en.wikipedia.org/wiki/Chronic_myelogenous_leukemia

http://www.patient.co.uk/health/Leukaemia-Chronic-Myeloid.htm

I won’t give away the ending of my story- you will just have to wait until you find the novel on the shelves 😉

Rachel