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Chronic myeloid leukemia

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  • 1. Chronic Myeloid Leukemia By Ganna (Anya) Brych
  • 2. General Overview • Also called: -chronic myelogenous leukemia -chronic granulocytic leukemia -chronic myelocytic leukemia. • mostly affects adults (chance increases in people 65 and older) • Can develop in children/younger people • Epidemiology= Can not be transmitted • Prognosis = live good-quality lives with medication
  • 3. Symptoms • Some don’t have symptoms in first stages Possible symptoms: -Leukopenia (shortage of normal white blood cells) -Neutropenia (low levels of normal neutrophils) -Thrombocytopenia (shortage of blood platelets) -Bleeding and bruising -Anemia -Shortness of breath
  • 4. Symptoms (cont.) Possible symptoms (cont.) : -Feeling of fullness in the abdomen -Fever -Enlarged lymph nodes -Night sweats -Weight loss -Loss of appetite -Recurrent infections
  • 5. Diagnosis • Blood Tests - a complete blood count (CBC) - lower-than-normal red cell count - abnormal number of platelets (either too high or too low) - High white cell count - a blood cell examination (test for leukemic blast cells and marrow cells) - high proportion of white cells
  • 6. Diagnosis (cont.) • Bone Marrow Tests - bone marrow aspiration (remove a liquid marrow sample) - bone marrow biopsy (remove a small amount of bone marrow) • measure the number/structure of chromosomes • determine any chromosome abnormality (Ph chromosome) • confirm blood test findings
  • 7. Diagnosis (cont.) • Hematopathologist confirms the diagnosis + identifies the phase • Looks for: -presence of the Philadelphia chromosome -number of cells with the Bcr-Abl oncogene Can Perform: • Cytogenetic analysis - identifies certain changes in chromosomes and genes by use of a karyotype • Fluorescence in situ hybridization (FISH) - detects Bcr-Abl using fluorescent dyes • Polymerase chain reaction (PCR) - identify and measure Bcr-Abl oncogenes not found by “FISH”
  • 8. Causes • Risk factors -exposure to very high doses of radiation -high-dose radiation therapy (radiotherapy) • Abnormal chromosome (Philadelphia or Ph chromosome) = translocation between chromosomes 22 and 9 • Causes development of cancer-causing gene (oncogene) Bcr-Abl
  • 9. Development • oncogene causes production of mutated protein called Bcr-Abl tyrosine kinase by stem cells • starts with a mutation to a single stem cell (in the bone marrow) • Stem cells form blood cells • multiplies into many cells • The CML cells grow and survive better than normal cells • Uncontrolled growth of CML cells = cancerous
  • 10. Phases • Each phase determined by the number of blast cells • Severity of symptoms increases • 3 Phases -Chronic Phase CML -Accelerated Phase CML -Blast Crisis Phase CML
  • 11. Chronic Phase CML • symptoms are mild or not noticeable. • white cells can still fight infection. • long-term drug therapy can control chronic phase • return to normal activities after treatment begins.
  • 12. Accelerated Phase CML • Low of red cells, • low number of platelets • an increase or decrease in white cells • a high number of blast cells • Symptoms may appear: -swollen spleen -stomach discomfort
  • 13. Blast Crisis Phase CML • increased number of blast cells in marrow and blood • low red cell and platelet counts • Symptoms : -infection -bleeding -a lack of energy or feelings of tiredness -shortness of breath -stomach pain (from an enlarged spleen) -bone pain • effects similar to those caused by an acute leukemia
  • 14. Treatment • 2001 FDA approved tyrosine kinase inhibitor drugs (most commonly used today) • Dose depends on the phase of CML • TKI drug therapy doesn't cure chronic phase CML -> stable remission • Regular blood and marrow tests to check progress of treatment
  • 15. Chronic Phase Treatment • Tyrosine kinase inhibitor (TKI) drugs -imatinib mesylate (Gleevec®) -dasatinib (Sprycel®) -nilotinib (Tasigna®) • If Initial Therapy Fails -interferon alpha (Roferon®-A and Intron® A) -pegylated interferon alpha -hydroxyurea (Hydrea®) -cytarabine (Cytosar-U®) -busulfan (Myleran®) ** harsher side effects **
  • 16. Accelerated Phase and Blast Crisis Phase Treatment • Tyrosine kinase inhibitor (TKI) drugs -imatinib mesylate (Gleevec®) -dasatinib (Sprycel®) -nilotinib (Tasigna®) • If Initial Therapy Fails -interferon -busulfan (Myleran®) -cytarabine (Cytosar-U®) -hydroxyurea (Hydrea®) • Leukapheresis (removal of white blood cells) • Stem cell transplant
  • 17. Bibliography • "BCR Rearrangement–Negative Chronic Myelogenous Leukemia Revisited." Journal of Clinical Oncology. American Society of Clinical Oncology, n.d. Web. 15 Mar. 2014. <http://jco.ascopubs.org/content/19/11/2915/F3.expansion>. • "Chronic Myeloid Leukemia (CML)." Learn About Cancer. American Cancer Society, n.d. Web. 15 Mar. 2014. • "Chronic Myeloid Leukemia." MedlinePlus. U.S. National Library of Medicine, n.d. Web. 15 Mar. 2014. <http://www.nlm.nih.gov/medlineplus/chronicmyeloidleukemia.htm l>.<http://www.cancer.org/cancer/leukemia- chronicmyeloidcml/index>. • "Chronic Myelogenous Leukemia." Leukemias. Memorial Sloan Kettering Cancer Center, n.d. Web. 15 Mar. 2014. <http://www.mskcc.org/cancer-care/adult/chronic-myelogenous- leukemia>. • Shah, Neil P. "Chronic Myeloid Leukemia." Disease Information and Support. The Leukemia and Lymphoma Society, n.d. Web. 15 Mar. 2014. <http://www.lls.org/#/diseaseinformation/leukemia/chronicmyeloidleuk emia/>.