Symptoms

Chronic myelogenous leukemia often doesn't cause symptoms. It might be detected during a blood test.

When they occur, symptoms may include:

• Bone pain.
• Bleeding easily.
• Fatigue.
• Fever.
• Weight loss without trying.
• Loss of appetite.
• Excessive sweating during sleep.

Diagnosis

Tests and procedures used to diagnose chronic myelogenous leukemia include:

• Physical exam.Your health care provider examines you and checks vital signs such as pulse and blood pressure. Your provider also feels your lymph nodes, spleen and abdomen for swelling.
• Blood tests.CBC checks the number of different types of cells in the blood. Chronic myelogenous leukemia often causes a very high number of white blood cells. Blood tests also can measure organ function to show if anything isn't working properly.
• Bone marrow tests.Bone marrow biopsy and bone marrow aspiration are used to collect bone marrow samples for testing. The samples go to a lab for testing.
• Tests to look for the Philadelphia chromosome.Specialized tests are used to analyze blood or bone marrow samples for the presence of the Philadelphia chromosome or the BCR-ABL gene. These tests may include fluorescence in situ hybridization analysis, also called FISH, and polymerase chain reaction test, also called PCR.
  • Treatment principles

 Chronic myeloid leukemia occurs in three phases that follow each other. These are as follows:

• The chronic phase is characterized by the availability of up to 10% of blast cells in the blood.
• The acceleration phase involves a quick accumulation of blast cells in the body, and a patient has more than 10%, but less than 20% of blast cells detected in the blood.
• the blast crisis phase occurs when the blood contains 20% or more blast cells.

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:

• increase the dose of drugs.
• change the drug. 
• use chemotherapy or interferon.
• perform stem cell transplantation (in young patients, if a suitable donor can be found).

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.

• Targeted therapy

 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

 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.

• Chemotherapy

 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:

• the lack of effect from tyrosine kinase inhibitors,
• the transition of the disease to the acceleration phase,
• the necessity to quickly reduce the number of blast cells in the blood and reduce the size of the spleen,
• before stem cell transplantation. 

• Local treatment methods

 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: 

• irradiation of the enlarged spleen, which puts pressure on the stomach and makes it difficult for food to pass,
• local irradiation of brain metastases (rare option),
• bone irradiation in the case of severe pain syndrome,
• treatment of the disease in the blast crisis phase, if chronic myeloid leukemia has transformed into acute lymphoblastic leukemia (but this rarely happens),
• preparation for stem cell transplantation (radiation therapy can rarely complement high-dose chemotherapy).

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.

• Stem cell transplant

 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:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical blood test
• inflammation markers (CRP, ESR)
• blood coagulation analysis (aPTT, PT, INR)
• blood smear
• ultrasound of spleen, CT scan (if clinically indicated)
• aspiration biopsy of bone marrow: (if clinically indicated)
• immunohistochemical study
• cytogenetic analysis (Philadelphia chromosome detection)
• nursing services
• services of all leading experts
• explanation of individual treatment plan 

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Bone marrow biopsy results (if available)

Price from: On request

Type of program: Outpatient

Expected duration of the program: 6 days

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2-Chemotherapy:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• blood smear
• TSH-basal
• inflammation indicators
• indicators blood coagulation
• CT scan of full body, ultrasound of spleen
• aspiration biopsy of bone marrow
• cytogenetic analysis for Philadelphia chromosome detection
• cytogenetic analysis with standard karyotyping
• chemotherapy and immunotherapy (for one cycle)
• symptomatic treatment
• control examinations
• cost of essential medicines and materials
• nursing services
• full hospital accommodation
• explanation of future recommendations

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Bone marrow biopsy results (if available)

Price from: on request

Type of program: Inpatient

Expected duration of the program: 21 days