CML or chronic myelogenous leukemia, also referred to as chronic myeloid leukemia is a cancer affecting the bone marrow (the soft portion present inside the bones where different types of blood cells are produced) and blood cells. CML generally occurs in older adults and very rarely affects children, although it may occur in people of any age. It is imperative to detect the symptoms of CML early as the response to treatment is better when it is started early.

CML Symptoms

Around 25% of people suffering from CML present with no symptoms at the time of diagnosis. Their CML is diagnosed on the basis of routine blood tests and many symptoms are caused by some other illness. Symptoms, if present, are initially mild and gradually become worse.

• Getting infections easily and more often: As the abnormal white blood cells increases, you may get infections more often and easily. This happens because the abnormal cells are unable to fight off infections.
• Unexplained weight loss: You may lose weight even on a normal diet. If your spleen has become enlarged, then it may press upon your stomach, making you feel full quickly, thereby decreasing your eating capacity and reducing your weight.
• Fatigue and pale appearance: Feeling tired and fatigued is one of the common CML signs. This is due to shortage of red blood cells, leading to anemia. It can also result in breathlessness and pale appearance of the skin.
• Abnormal bleeding or bruising: Reduced platelets in the blood can result in abnormal bruising or bleeding. You may bruise easily with no apparent cause. You may bleed from nose or gums. Rarely, people develop dark red spots or fine rash also referred to as purpura. Some persons may also have blood in stools or urine.
• Discomfort in the abdominal region: The spleen, an organ present on the left side of abdomen can swell and become large, resulting in pain or discomfort in your abdominal region.
• Reduced appetite: Your appetite may reduce gradually due to the pressure caused on the stomach by the swollen and enlarged spleen.
• Occurrence of night sweats: You may develop sudden onset of fever and sweating, especially at night.
• Headaches: If your white blood cells become very high, they can clog the small blood vessels present in the brain resulting in headache, which is also one of the CML symptoms.
• Pain in bones: In some cases, bone pain may occur due to the abnormal white blood cells collecting in the bone marrow, creating pressure on nerves, thereby resulting in pain.
• Swelling of lymph glands: Swelling of lymphatic glands may occur due to the collection of abnormal WBCs in them.

Some of the less common CML signs, which usually occur during the later stages are:

• Changes in eyesight: Very high WBC count can clog the small blood vessels of the eyes, leading to eye problems.
• Painful, swollen joints: Your joints may swell and become painful due to collection of salts in the body tissues.
• Persistent erections that are painful: Also referred to as priapism, this is a very rare symptom of CML. The high number of WBCs clogs the small blood vessels of the penis, leading to persistent erection that becomes painful. It is an emergency medical condition that requires immediate medical attention. The penis may be permanently damaged due to an erection which lasts for a long time.
• Kidney damage: In some people, who have advanced disease the kidneys may be damaged.

When to Visit a Physician?

If you develop any of the above mentioned CML symptoms, you should visit your physician and get yourself evaluated. However, these symptoms may be produced due to certain other medical illnesses also. Most of the people who have these symptoms may not be diagnosed with CML.

CML Diagnosis and Treatment

Diagnosis

Procedures and tests that are used to diagnose CML are:

• Physical examination: Your physician will conduct a physical exam and check vital signs such as blood pressure and pulse. They will also check your spleen, abdomen and lymph nodes for any abnormalities.
• Blood tests: Your physician will order a blood test to check for abnormalities in blood cells. Blood tests to measure function of an organ may also detect abnormalities that may help your physician in making a diagnosis.
• Bone marrow tests: Bone marrow aspiration and bone marrow biopsy are done to collect samples of bone marrow for testing in laboratory. The bone marrow is collected from your hip bone if you have CML symptoms.
• Test to check for Philadelphia chromosome: Special tests including PCR (polymerase chain reaction test) and FISH (fluorescence in situ hybridization analysis) help in analyzing bone marrow or blood samples to check for the presence of the BCR-ABL gene or the Philadelphia chromosome.

Treatment

The aim of treatment is to destroy abnormal blood cells and restore the levels of healthy blood cells. It is generally not possible to destroy all the abnormal cells.If you receive treatment during the initial, chronic stage of CML, the disease can be prevented from progressing to a more advanced stage.

1. Medications

Physicians usually give medicines called as TKIs or tyrosine kinase inhibitors initially. These medicines reduce the rate of production of leukemia cells in your body. Some of these drugs that are commonly used are:

• Imatinib (Gleevec)
• Dasatinib (Sprycel)
• Nilotinib (Tasigna)

You may receive ponatinib (Iclusig) and bosutinib (Bosulif) if other medicines don’t help or worsen your symptoms.

If your condition continues to worsen after you have received 2 or more TKIs, you may receive another medicine referred to as Synribo (omacetaxine mepesuccinate).

2. Other Treatments

Other options to treat CML are biologic therapy and chemotherapy. In biologic therapy, a drug referred to as interferon is given to activate the immune system.

A complicated procedure called stem transplant may be done in some patients when all other treatments have failed. Stem cells used in stem transplant are cells that are present in your bone marrow and produce new blood cells. During a stem cell transplant, new stem cells are supplied by a donor.

Close relatives including your sister or brother can be a good match for stem transplant. If this doesn’t work, then you will have to get the donor from a list of potential donors. Sometimes, the best chances for getting right stem cells are from someone who belongs to the same ethnic or racial group as you.