Chronic Myeloid Leukaemia
About the condition
Leukaemia is cancer of the white blood cells. The term chronic leukaemia is used to describe the type of cancer that progresses slowly over many years, people with chronic leukaemia often show few symptoms for many years. This means that the condition is often diagnosed coincidentally, during routine check-ups or blood tests for other issues.
Chronic leukaemia is further classified according to the type of white blood cells that are affected by cancer – chronic myeloid leukaemia (CML) affects the myeloid cells, which perform a number of different functions, such as fighting bacterial infections, defending the body against parasites and preventing the spread of tissue damage
Chronic myeloid leukaemia is quite a rare type of cancer. Around 8,600 people are diagnosed with leukaemia every year in the UK, and it is more common in people aged 40-60.
What triggers the development of chronic leukaemia and causes the initial mutation in stem cells is unknown, although there are many suspected risk factors. There is some evidence to show an increased risk of chronic leukaemia in people who:
- are obese
- have a weakened immune system – due to HIV or AIDS or taking immunosuppressants after an organ transplant
- have inflammatory bowel disease – such as ulcerative colitis or Crohn’s disease
In its early stages, chronic myeloid leukaemia usually causes no noticeable symptoms and is often diagnosed during tests for a different condition. When symptoms do develop, they are similar to those of many other illnesses and can include:
- frequent infections
- unexplained weight loss
- a feeling of bloating
- less commonly, swollen lymph nodes – glands found in the neck and under your arms, which are usually painless
CML can also cause swelling in your spleen (an organ that helps to filter impurities from your blood). This can cause a lump to appear on the left side of your abdomen, which may be painful when touched. A swollen spleen can also put pressure on your stomach, causing a lack of appetite and indigestion.
If any of these symptoms apply to you, or if you have any concerns about similar symptoms, it is essential that you see your doctor at once, as your chances of recovery are much higher if your cancer is diagnosed early.
If you are referred to CCL for diagnosis, your consultant or oncologist will advise you as to which tests are relevant, however most cases of chronic myeloid leukaemia are often first detected when a routine blood test is carried out to diagnose another, unrelated, condition. Once CML is suspected, tests include:
- A blood test, to check for a high number of abnormal white blood cells in the sample
- A bone marrow biopsy, during which a haematologist will take a small sample of bone marrow to examine under a microscope. This involves inserting a needle into a large bone, usually the hip bone, to extract the marrow, and is done under local anaesthetic
- Cytogenetic testing, which involves identifying the genetic make-up of the cancerous cells. There are specific genetic variations that can occur during leukaemia, and knowing what these variations are can have an important impact on treatment.
- A polymerase chain reaction (PCR) test, which can be done on a blood sample. This is an important test to diagnose and monitor the response to treatment.
- A Computerised Tomography (CT) scan, which shows a 3D image of the area being looked at
- An X-ray, which is when low level radiation is used to create an image of the body
At CCL, patients with CML are treated by a team of different specialists, called a Multi-Disciplinary Team, or MDT, from our Haemato-Oncology department, headed by Professor Ray Powles, CBE. This team works together to create a treatment plan to suit the individual needs of the patient. Because CML is a chronic condition, the first treatment is usually medication to stop the progression of the cancer.
Imatinib tablets are usually given as soon as you have been diagnosed with chronic myeloid leukaemia, to slow its progression. These tablets are taken every day for life, and most patients do really well on them.
The aim of treatment is to achieve the following:
- by three months, correct the blood count
- by 12 months, clear the bone marrow of cells containing the Philadelphia chromosome
- by 18 months, get to a stage where the leukaemia can only be detected by a very sensitive molecular test (molecular remission)
If the leukaemia reaches an advanced stage, further treatment is considered, including:
- Chemotherapy, which involves the use of chemical agents which are toxic to cancer cells, destroying them and preventing them from spreading to different areas. This can be given by injection or in tablet form.
- A bone marrow or stem cell transplant, which is a possible alternative if chemotherapy has been unsuccessful. Before transplantation can take place, the patient will need to have intensive high-dose chemotherapy and radiotherapy to destroy the cells in their bone marrow. The donated stem cells are then given through a tube into a blood vessel, in a similar way to chemotherapy medication.
We offer a wide range of services for patients, as well as their loved ones, designed to make a very difficult time as easy as possible, and to give our patients the best treatment and support possible. Our support services include a specialist counselling, specialist physiotherapy, group sessions and much more. You can find the full range of our support services here.
We’ll be with you every step of the way.
If you have any questions about cancer or would like to book an appointment with one of our specialists, complete this form online or call 020 8247 3351.
Chronic Myeloid Leukaemia Consultants