Chronic myeloid leukaemia
Chronic myeloid leukaemia (CML) is a type of cancer that affects the white blood cells and tends to progress slowly over many years.
CML can occur at any age, but is most common in older adults around 60-65 years of age. In CML, the spongy material inside some bones (bone marrow) produces too many myeloid cells – immature white blood cells that aren’t fully developed and don’t work properly. CML is different to other types of leukaemia, including chronic lymphocytic leukaemia, acute myeloid leukaemia and acute lymphoblastic leukaemia. Symptoms CML doesn’t usually have any symptoms in its early stages and may only be picked up during tests carried out for another reason. As the condition develops, symptoms can include:
- weight loss
- night sweats
- tenderness and swelling in the left side of our tummy
- feeling full after small meals
- pale skin and shortness of breath
- a high temperature (fever)
- bruising and bleeding easily
- frequent infections
- bone pain When to see your GP See your GP if you have any persistent symptoms that you’re worried about. The symptoms above can have many different causes, so it’s unlikely you have CML, but it’s a good idea to get them checked out.
Your GP can arrange for a blood test to check for possible causes of your symptoms. If this detects a problem, you may be referred to a hospital specialist for further tests. How CML is diagnosed Your GP will ask about your symptoms and may carry out a simple examination to check for other problems, such as swelling in one side of your tummy. A sample of your blood may also be sent to a laboratory so it can be checked for possible causes of your symptoms. A very high level of white blood cells in your blood could be a sign of leukaemia. If this is detected, you’ll be referred to a haematologist (specialist in blood conditions) for further tests.
To confirm a diagnosis of leukaemia, a sample of your bone marrow will need to be removed during a procedure called a bone marrow biopsy.
During a biopsy:
- an area of skin at the back of your hip is numbed with local anaesthetic
- a needle is used to remove a small sample of bone marrow
- you may experience some discomfort while it’s carried out, but it shouldn’t be painful The procedure usually takes around 15 minutes and you won’t normally need to stay in hospital overnight. You may have some bruising and discomfort for a few days afterwards. Your bone marrow will be checked for cancerous cells and the cells will be analysed to identify which type of leukaemia you have and how advanced it is. This can help your doctors determine the best treatment for you. Treatments for CML Treatment for CML is usually started straight away to help slow down its progression and keep it under control. The main treatments are medications called tyrosine kinase inhibitors that stop the cancer cells growing and multiplying. They can help keep CML under control if taken for life.
These medicines include:
- imatinib tablets
- nilotinib capsules
- dasatinib tablets
- bosutinib tablets
Regular blood tests will be carried out to check the medication is working. Occasionally, it may be possible to have a stem cell transplant. Stem cells are cells that go on to form other types of cell. In this case, stem cells from your bone marrow are transplanted, which can produce healthy white blood cells.
A stem cell transplant can potentially cure CML, although it’s a very intensive treatment and isn’t suitable in many cases.
CML is a serious and life-threatening condition, but with the introduction of newer tyrosine kinase inhibitors, the outlook is much better now than it used to be. It is estimated that around 85-95% of people will now live at least five years after their diagnosis, and that many people will probably live much longer than this. It is thought life expectancy may not be affected at all in some cases, as long as treatment is continued and the outlook is generally better the earlier CML is diagnosed.