Definition

Chronic myelogenous leukemia (CML) is a cancer of the blood and bone marrow. It is marked by changes in:

• Myeloblasts— immature white blood cells (mature ones help the body fight infection)
• Red blood cells (RBCs)—cells that carry oxygen
• Platelets—cells that help blood to clot

CML is often slow growing for many years. Over time, it may change into acute myelogenous leukemia (AML). AML is a faster and more serious type of leukemia.

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Causes

In CML, the abnormal cells grow and crowd out other blood cells. This leads to problems with infections and bleeding.

CML is almost always linked to changes in a gene. The gene change may be caused by exposure to large amounts of radiation. However, in many people, the cause is not known.

Risk Factors

CML is more common in older adults and men. Other things that may raise the risk are:

• Exposure to atomic bomb radiation
• Exposure to a nuclear accident

Symptoms

CML may cause:

• Tiredness, weakness
• Night sweats
• Weight loss without trying
• Fever
• Pain or a feeling of fullness below the ribs
• Bone or joint pain
• Unusual bleeding or bruising
• Painless swelling in the neck, underarms, stomach, or groin

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. The doctor will check for swelling of the liver, spleen, or lymph nodes.

Tests may include:

• Blood tests
• Bone marrow biopsy— to remove and test a sample of bone marrow
• Cytogenetic analysis—to look for DNA changes in certain white blood cells
• Immunophenotyping—to check for certain markers in white blood cells

Testing confirms CML diagnosis.

For certain symptoms, imaging tests may be done to look at body structures. They may be:

• Chest x-ray
• CT scan
• MRI scan
• Ultrasound

CML is grouped into 3 phases. This helps the doctor know what to expect and what treatments to use.

Treatment

The goal is to get rid of the cancer cells. Treatment depends on person's age, health, and phase of the CML. Options may be:

• Targeted therapy—drugs that turn off certain genes and molecules
• Chemotherapy by mouth, injection, or IV—to kill cancer cells
• Stem cell transplant—blood cells given from a donor
• Donor lymphocyte infusion—a donor's white blood cells are given
• Splenectomy—surgery to remove the spleen if it grows too big or causes problems

Prevention

There are no guidelines to prevent CML.