Chronic Myeloid Leukaemia: Uncommon cancer of white blood cells

We have grown to understand the term Leukaemia as a form of cancer that starts in the blood or blood-forming tissues. There are multiple types of leukaemia, those that are chronic and then those that are acute. Chronic Myeloid Leukaemia is an uncommon cancer of the white blood cells that slowly progresses in the bone marrow. It is a non-threatening condition with a person being able to maintain their quality of life with oral medicines giving excellent long-term results. According to a study by NCBI, although the efficacy of treatment available has dramatically improved the disease-specific overall survival rate with 15 per cent of adult leukemias being chronic myeloid leukaemia, the prevalence of CML is rising globally.

How can it be detected?

The signs indicating CML can be vague and are most often caused by other things. These include:

  • Weakness
  • Fatigue
  • Sweating at rest
  • Weight loss without cause
  • Fever and Bone pain
  • Feeling of mass under the left side of the ribcage (which is caused due to an enlarged spleen)
  • Sense of fullness in the belly

These aren’t particularly CML signs and can happen with other cancers, as well as with many conditions that aren’t cancer. Perhaps the most effective way of detecting CML is through a complete routine blood test. Complete Blood Count (CBC) test measures the RBCs, WBCs, and platelets in a sample of blood. It also measures the amount of haemoglobin in the red blood cells and the percentage of red blood cells in the sample. Patients with CML often have decreased RBC count and a possible increase or decrease in the number of platelets, depending on the severity of the cancer. Additionally, a peripheral blood smear can also be performed.

What do these tests tell us? The proportion of immature cells compared to the proportion of maturing and fully matured white blood cells. These immature cells are generally not present in the blood of a healthy patient.

How can CML be managed in the long run?

There are multiple forms of treatments currently available for CML and the method your doctor recommends may vary depending on each person. The most common form of treatment that has also received great success in CML patients is through Tyrosine kinase inhibitors (TKIs). TKIs are a type of targeted therapy that come as pills to be taken orally. This targeted therapy identifies and attacks the specific cells causing cancer. Essentially, these TKIs in CML target the abnormal BCR-ABL1 protein that causes uncontrolled CML cell growth. It blocks the function causing the cancerous cells to die.

Once detected, it is important to closely monitor CML. There are several tests one can get to monitor one’s response throughout their treatment journey, and they should be taken with a gap between each. While these tests occur more frequently in the first year, they may become less frequent thereafter. Of course, the journey you take on may look different, hence you can discuss with your healthcare team to understand the frequency that works best for you.

What can one anticipate once diagnosed?

The treatments and predictions for people diagnosed with Chronic Myeloid Leukaemia are generally good, and today with the support of better treatments, it is getting even better. The treatments currently available have gotten even better than their predecessors at targeting tyrosine kinase, the protein that causes CML. If you have been recently diagnosed with the disease, it is important to remember that there is effective treatment available for you. You along with your healthcare team can ensure that you not only keep the disease in check/controlled but also ensure that your quality of life is not affected in the process. Be sure to journal any changes that happen during treatment and afterwards, too. This discussion can and should include not only your physical but emotional and social journey with CML.

The author is Director – Haematology, Haemato-Oncology & Bone Marrow Transplant, Director of Fortis Institute of Blood Disorder, Fortis Hospital Mulund. Views are personal.

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