Diagnosis

  • Physical examination: Vital signs such as pulse and blood pressure will be checked. Lymph nodes, spleen and abdomen need to be examined to see if they have grown from normal size.
  • Blood tests:
    • Complete blood count. To see the abnormalities present in blood cells, such as extensive amount of white blood cells. 
    • Blood chemistry tests. To evaluate the functions of the organs, which could show the abnormalities and help making the diagnosis.
  • Bone marrow biopsy and bone marrow aspiration: To gather bone marrow samples from the hipbone and send for laboratory tests. 
  • Tests to find out the Philadelphia chromosome: Fluorescence in situ hybridization (FISH) analysis and the polymerase chain reaction (PCR) test are specialized procedures that analyze blood or bone marrow samples to find the Philadelphia chromosome or the BCR-ABL gene.

Chronic myelogenous leukemia is classified into phases according to the severity of the disease. The phase is evaluated by the proportion of diseased cells to the healthy cells in the blood or bone marrow. If the number of diseased cells is high, it indicates that chronic myelogenous leukemia is at an advanced phase. 
The phases of chronic myelogenous leukemia include:

  • Chronic is the initial stage and commonly results in the best response to treatment.
  • Accelerated is the transitional phase from minor to more severe.
  • Blast is a severe stage that leads life-threatening condition. 

Treatment

Chronic myelogenous leukemia treatment aims to remove blood cells that consist of abnormal BCR-ABL gene, which causes excess number of diseased blood cells. For primary cases, treatment starts with targeted drugs.  

Targeted drug therapy 

Targeted drugs work by attacking certain aspects of cancer cells that grow and multiply.
Its goal is to achieve a long-term remission of the disease. For chronic myelogenous leukemia, the protein produced by the BCR-ABL gene tyrosine kinase are targeted. 

Targeted drugs that hinder the action of tyrosine kinase are Imatinib (Gleevec), Dasatinib (Sprycel), Nilotinib (Tasigna), Bosutinib (Bosulif) and Ponatinib (Iclusig).  

Patients who have been diagnosed with chronic myelogenous leukemia are treated by targeted therapy drugs at the first stage. Side effects include, skin swelling or puffiness, nausea, muscle cramps, fatigue, diarrhea and skin rashes.  

To evaluate the effectiveness of targeted therapy, blood tests are carried out to find the presence of the BCR-ABL gene. If chronic myelogenous leukemia does not respond well to targeted therapy or becomes resistant to it, alternative targeted drugs will be considered.

Bone marrow transplant (stem cell transplant) 

Bone marrow transplant is the only treatment option that can be used as a definite cure for chronic myelogenous leukemia. Although this treatment tend to be reserved for patients who did not have good response to other treatments, because bone marrow transplants hold a high risk and chance for complications to arise. The procedure is done by giving extensive doses of chemotherapy, which are aimed to kill blood-forming cells in the bone marrow. Blood stem cells that have taken from a donor are then infused with in the bloodstream. The new cells produce new healthy blood cells and replace the cells that are diseased.    

Chemotherapy

Chemotherapy is a drug that is designed to kill rapidly growing cancer cells, including leukemia cells. The drug is often given with the combination of targeted therapy to treat advanced stage of chronic myelogenous leukemia. 

Chronic myelogenous leukemia (CML)