Chronic myeloid leukemia is a type of blood cancer that begins in the bone marrow and develops as a result of the uncontrolled division of precursor cells of red blood cells, platelets, and most types of white blood cells. The transformation of a normal cell into a leukemia cell is initiated by a mutation in the BCR-ABL gene. In patients with chronic myeloid leukemia, a large number of defective cells that are unable to perform their functions enter the bloodstream. The disease mainly affects adults and is very rare in children. Chronic myeloid leukemia is not as aggressive as other blood cancers, such as acute lymphoblastic leukemia. Nonetheless, at the same time, it is a more challenging task to cure it completely, especially if it spreads to the brain. Therapy can be continued continuously for many years.
Symptoms
Chronic myelogenous leukemia often doesn't cause symptoms. It might be detected during a blood test.
When they occur, symptoms may include:
Diagnosis
Tests and procedures used to diagnose chronic myelogenous leukemia include:
Chronic myeloid leukemia occurs in three phases that follow each other. These are as follows:
Chronic phase. Typically, patients with chronic myeloid leukemia in the chronic stage receive one of the tyrosine kinase inhibitors. If the treatment for such patients does not work or causes any side effects, doctors prescribe another drug.
Doctors perform PCR-based diagnostics for the BCR-ABL gene and check the bone marrow for the presence of the Philadelphia chromosome to improve treatment results. The follow-up examination is carried out for the first time 3 months after the start of therapy, and then again, every six months. After 3 months of therapy, a complete hematological response should be achieved, as well as a partial cytogenetic response and a reduction in the number of BCR-ABL copies by at least 10 times. After 18 months, a complete response should be achieved in all three of the following parameters: hematological (blast cells), cytogenetic (bone marrow examination), and molecular (absence of BCR-ABL copies).
At least 70% of patients achieve a complete response after a year of treatment, and with the use of new drugs, the effectiveness is even higher. However, a complete response does not mean a cure for the disease, so therapy will be continued. If a complete response persists for 2-3 years, doctors can reduce the dosage of drugs and even stop their intake, but at the same time, a patient will be carefully monitored so that, in the event of a recurrence of the disease, treatment of chronic lymphoblastic leukemia can be continued. A brain imaging study can be also performed in order to exclude this type of complication. If the brain is involved, additional interventions are required.
For some people, primary treatment does not work. In such cases, doctors use measures to improve the effectiveness of treatment. For example, they:
Acceleration phase. The number of blast cells in the blood increases, which causes the manifestation of symptoms. Treatment is generally the same as in the chronic phase, but the response rate is lower. Doctors are more likely to use new drugs from the group of tyrosine kinase inhibitors. A combination of interferon drugs, chemotherapy, and targeted therapy can sometimes be used as well. In this phase, doctors often perform donor stem cell transplantation, although better results can be achieved if the disease is still transferred to the chronic phase before the transplantation. Sometimes healthcare professionals perform transplantation of the patient's own stem for this purpose. This treatment option does not cure cancer but provides a remission of the disease.
Blast crisis phase. The course of this phase is the same as acute leukemia. There are more cells and they are more malignant. If cancer is first detected in this phase, then treatment will be immediately started with high doses of tyrosine kinase inhibitors and with new drugs from this group. Standard chemotherapy only works in 20% of patients, and the remission achieved is short-lived. Only donor stem cell transplantation helps to cure the disease at this stage. In the blast crisis phase, it is much less effective than in the chronic phase of blood cancer. Blasts spread throughout the body and can affect the brain. If such a complication is detected, additional interventions on the brain may be required. For instance, brain metastases can be destroyed with the help of laser ablation.
The mainstay of treatment is tyrosine kinase inhibitors targeting the abnormal BCR-ABL gene. 3 drugs have already been approved for the treatment of chronic myelogenous leukemia. As a rule, doctors use one drug only, and it must be taken for a long time. If one tyrosine kinase inhibitor is not effective, doctors prescribe another one. These drugs work best in the chronic phase, but they usually do not cure the disease permanently, so long-term therapy is required.
Immunotherapy involves the use of interferon preparations. It can be used only in cases where targeted therapy no longer works. The effect of interferons is weaker, and they cause more side effects. Besides, these drugs have to be injected every day.
Today, chemotherapy is used much less often than before, as targeted therapy is usually more effective. However, sometimes the need for the use of cytostatic chemotherapy arises. This can be prescribed in the following cases:
Local methods of treatment include radiation therapy and surgery. The need for these methods of treatment is rare.
Radiation therapy can be used in the following cases:
Surgery for myeloid leukemia does not play a role in curing the disease or achieving a remission. A surgical procedure can be performed exclusively for symptomatic purposes. Sometimes doctors have to do a splenectomy.
If standard treatment does not work, myeloid leukemia in young patients can be treated with stem cell transplantation. Since the patient's own bone marrow is damaged, and the cells contained in it may cause cancer recurrence, donor stem cells are used for the transplant. These stem cells can be harvested from a sibling, provided that the antigens match. If there is no suitable donor among the relatives, a donor will be searched for in a multi-million donor database and an unrelated transplantation will be performed.
The treatment begins with high-dose chemotherapy. A patient receives higher doses of drugs than usual, as there is no need to save their own bone marrow. In the process of treatment, it is irreversibly damaged. At the same time, doctors usually manage to cure blood cancer, and the bone marrow is subsequently restored with a stem cell transplant. Stem cells are injected intravenously, and after a few weeks, the new bone marrow begins to produce blood cells. Patients spend this time in a sterile box, since they have virtually no immunity and any infection becomes deadly.
A stem cell transplant usually helps to cure blood cancer or at least achieve a complete response that lasts a long time.
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1- Diagnosis:
The program includes:
Required documents
Price from: On request
Type of program: Outpatient
Expected duration of the program: 6 days
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2-Chemotherapy:
The program includes:
Required documents
Price from: on request
Type of program: Inpatient
Expected duration of the program: 21 days
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