Chronic Myelogenous Leukemia

Chronic Myelogenous Leukemia (CML), also known as chronic myeloid or chronic myelocytic leukemia, is a malignant cancer of the myeloid line of cells in the bone marrow that results in the uncontrolled growth of white blood cells in the bone marrow, blood, and body tissues. It is estimated that about 5,000 people in the United States are diagnosed with CML each year. CML affects males more than females and usually occurs in middle age adults. Although children can also develop the disease, childhood cases of CML account for only about 2% of all people who develop the condition.

The exact cause of CML is not known but research over the past 40 years has expanded our understanding of the genetic and molecular events that lead to the development of CML. The major genetic abnormality that is observed in the marrow cells of more than 90% of patients with CML is the Philadelphia (Ph) chromosome. Many patients in the early stages of CML have no symptoms while others may have non-specific symptoms such as generalized fatigue, fever, night sweats, or an enlarged spleen. In many cases, CML is diagnosed during a routine blood test which shows an abnormal increase in white blood cells (leukocytosis). The hallmark for diagnosis of CML is demonstrating the presence of the Philadelphia (Ph) chromosome in bone marrow cells.

Three clinical stages of CML are recognized which are important in terms of predicting the prognosis (outlook) as well as planning treatment for the disease. The three clinical stages of CML include the chronic-phase; the accelerated-phase; and the blastic-phase. Approximately 80% of patients with CML are diagnosed in the chronic-phase of the disease which can last from a few months to about 4-5 years. The chronic-phase can usually be controlled with medications. Nearly 80% of patients with CML will progress from the chronic-phase to the accelerated-phase of the disease which is a more advanced stage of the disease. Clinical symptoms of CML as well as blood abnormalities become more prominent during the accelerated-phase of CML. The third stage of CML is known as the blastic-phase and is the the most advanced stage of the disease. It is called the "blastic-phase" because 30% or more of immature, leukemic white blood cells called "blasts" are found in the bone marrow and blood. When clinical symptoms of CML occur in the blastic-phase of the disease, this is known as "blast crisis".

The treatment options for patients with CML depend to a large extent upon the patient's age, stage of the disease, and overall health. In general, the treatment options for CML can be divided into drug therapy and stem-cell transplantation based therapy. Currently, the only known treatment which is potentially curative for CML is allogeneic stem cell transplantation. A variety of different drugs are used for the treatment of CML and can usually control the disease, especially in the early chronic-phase of CML but they do not cure the disease. Imatinib mesylate (Gleevec), a drug that was approved by the FDA in 2001 for the treatment of CML, has had a dramatic impact on the treatment of CML and has improved the prognosis for many patients.

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