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/>.