Chronic myeloid leukaemia

Chronic myeloid leukaemia - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Chronic myeloid leukaemia Chronic myeloid leukaemia About chronic myeloid leukaemia Symptoms of chronic myeloid leukaemia Causes of chronic myeloid leukaemia Diagnosing chronic myeloid leukaemia Treating chronic myeloid leukaemia Complications of chronic myeloid leukaemia About chronic myeloid leukaemia Leukaemia is cancer of the white blood cells. Chronic leukaemia means the condition progresses slowly over many years. Chronic leukaemia is classified according to the type of white blood cells that are affected by cancer. There are 2 main types: lymphocytes  mostly used to fight viral infections myeloid cells  which perform a number of different functions, such as fighting bacterial infections, defending the body against parasites and preventing the spread of tissue damage These pages focus on chronic myeloid leukaemia, which is a cancer of the myeloid cells. The following other types of leukaemia are covered elsewhere: chronic lymphocytic leukaemia acute myeloid leukaemia acute lymphoblastic leukaemia What happens in chronic leukaemia Your bone marrow produces stem cells. These are unique cells because they have the ability to develop into three important types of blood cell: red blood cells  which carry oxygen around the body white blood cells  which help fight infection platelets  which help stop bleeding In leukaemia, a genetic mutation in the stem cells causes a huge over-production of white blood cells and a corresponding drop in red blood cells and platelets. Its this lack of red blood cells which causes symptoms of anaemia, such as tiredness, and the lack of platelets that increases the risk of excessive bleeding. Warning signs of chronic myeloid leukaemia In its early stages, chronic myeloid leukaemia usually causes no noticeable symptoms. As the condition develops, symptoms include: tiredness weight loss night sweats a feeling of bloating bruising bone pain Read more about the symptoms of chronic myeloid leukaemia How common is chronic myeloid leukaemia? Chronic myeloid leukaemia is quite a rare type of cancer. Chronic myeloid leukaemia can affect people of any age, but it is more common in people aged 40 to 60. There is no evidence that it runs in families. Symptoms of chronic myeloid leukaemia In its early stages, chronic myeloid leukaemia usually causes no noticeable symptoms and it is often diagnosed during tests for a different condition. When symptoms do develop, they are similar to those of many other illnesses and can include: tiredness frequent infections unexplained weight loss a feeling of bloating less commonly, swollen lymph nodes  glands found in the neck and under your arms, which are usually painless Chronic myeloid leukaemia can also cause swelling in your spleen (an organ that helps to filter impurities from your blood). This can cause a lump to appear on the left side of your abdomen, which may be painful when touched. A swollen spleen can also put pressure on your stomach, causing a lack of appetite and indigestion. The symptoms of chronic myeloid leukaemia in its advanced stage will be much more noticeable and troublesome. They include: severe fatigue bone pain night sweats fever easily bruised skin Causes of chronic myeloid leukaemia Chronic myeloid leukaemia is caused by a DNA mutation in the stem cells which produce white blood cells. The change in the DNA causes thestem cells toproduce more white blood cells than are needed. They are also released from the bone marrow before they are matureand able to fight infection like healthy adult white blood cells. As the number of immature cells increases,the number ofhealthy red blood cells and platelets fall, and its thisfallwhich causes many of thesymptoms of chronic leukaemia. Philadelphia chromosome Although the cause of chronic myeloid leukaemia is genetic, it is not inherited as it is an acquired genetic abnormality. Most people with the condition have an abnormal chromosome, where a section of DNA from one chromosomehas been swapped with a section from another. This is called thePhiladelphia chromosome and it makes the cell produce a protein that encourages the leukaemic cells to resist normal cell death andgrow and multiply far more quickly than usual. Possible triggers for chronic leukaemia What triggers the development of chronic leukaemia and causes the initial mutation in stem cells is unknown. The one proven risk factor is exposure to radiation. However, radiation is only a significant risk if the levels are extremely high, such as those recorded after an atomic bomb explodes, or those released after a nuclear reactor accident, such as the one at Chernobyl. Benzene There is limited evidence that prolonged exposure to the chemical benzene leads to an increased risk of chronic myeloid leukaemia. Benzene is found in petrol and is also used in the rubber industry, but in the UKthere are strict controls to protect people from prolonged exposure. Benzene is also found in cigarettes. However, it is thought that smoking is more of a risk factor in acute leukaemia than it is in chronic leukaemia. Occupational risks A number of occupations have been linked to an increased risk of chronic leukaemia, possibly due to exposure to certain substances such as pesticides or chemicals. These occupations include: all types of agricultural workers people who are involved with rubber or plastic manufacture tailors and dressmakers cleaners builders labourer Other risk factors There is some evidence to show an increased risk of chronic leukaemia in people who: are obese have a weakened immune system  due to HIV or AIDS or taking immunosuppressants after an organ transplant have inflammatory bowel disease  such as ulcerative colitis or Crohns disease Diagnosing chronic myeloid leukaemia Chronic myeloid leukaemia is often first detected when a routine blood test is carried out to diagnose another, unrelated, condition. A blood test that reveals abnormally high levels of white blood cells could be a sign of chronic leukaemia. If you have a blood test with abnormal results, you will be referred to a haematologist (a specialist in treating blood conditions) for further testing. Bone marrow biopsy To confirm a diagnosis of chronic leukaemia, the haematologist will take a small sample of your bone marrow to examine under a microscope. This procedure is known as a bone marrow biopsy . A bone marrow biopsy is usually carried out under a local anaesthetic . The haematologist will numb an area of skin at the back of your hip bone, before using a needle to remove the bone marrow sample.Youmay experience some painonce the anaesthetic wears off andsome bruising and discomfort for a few days afterwards. The procedure takes around 15 minutes to complete and you should not have to stay in hospital overnight. The bone marrow sample will be checked to see if there are cancerous cells. Ifthere are, the biopsy will also be able to help determine which type of chronic leukaemia is present. Further tests There are a number of additional tests that can be used to help reveal more information about the progress and extent of the leukaemia. These can also provide an insight into how the leukaemia should be treated. Cytogenetic testing Cytogenetic testing involves identifying the genetic make-up of the cancerous cells. There are a number of specific genetic variations that can occur during leukaemia and knowing what these variations are can have an important impact on treatment. For example, 90% of people with chronic myeloid leukaemia have the Philadelphia chromosome. People who have thischromosome are known to respond well to a medicine called imatinib. Polymerase chain reaction (PCR) A polymerase chain reaction (PCR) testcan bedone on a blood sample. This is an important test to diagnose and monitor the response to treatment. The blood test is repeated every 3 months for at least 2 years after starting treatment, then less often once remission is achieved. Imaging tests In some cases, the hospital may want to perform some imaging tests to help rule out other conditions or confirm a diagnosis. This may be either: an X-ray  usually to examine your chest an ultrasound scan  usually to examine your spleen and liver Treating chronic myeloid leukaemia Imatinib tablets are usually given as soon as you have been diagnosed withchronic myeloid leukaemia, to slow its progression. These tablets are taken every day for life, and most patients do really well on them. The aim of treatment is to achieve the following: by 3 months, correct the blood count by 12 months, clear the bone marrow of cells containing the Philadelphia chromosome (see Causes page for information on this) by 18 months, get to a stage wherethe leukaemia can only be detected by a very sensitive molecular test (molecular remission) Chemotherapy is usually offered if the cancer reaches an advanced stage. Treating early-stage chronic myeloid leukaemia Imatinib A medicine called imatinib is the main treatment recommended for chronic myeloid leukaemia. It is usually given as soon as a diagnosis is made because the medicine is designed to slow the progression of the cancer and toprevent the condition reaching the accelerated or advanced phase. Imatinib is a type of tyrosine kinase inhibitor. This means it blocks a protein called tyrosine kinase(tyrosine kinasehelps to stimulate the growth of cancer cells). This reduces the production of abnormal white blood cells. Imatinib is taken as a tablet. The side effects of imatinib are usually mild and should improve with time. They include: nausea vomiting swelling in the face and lower legs muscle cramps rash diarrhoea Nilotinib It is estimated that 10to 40% of people who take imatinib become resistant to its effects, so an alternative treatment is required. The National Institute for Health and Care Excellence (NICE) has recommended nilotinib for the treatment of chronic myeloid leukaemia that is resistant or intolerant to imatinib. In some cases, nilotinib is recommendedas the first treatment. Nilotinibworks in a similar way to imatinib in that it blocks the effects of proteins that help stimulate the growth of cancer cells. Side effects of nilotinib can include: vomiting abdominal pain bone and joint pain dry skin loss of appetite hair loss insomnia night sweats dizziness tingling or numbness If theside effects become particularly troublesome, temporarily stopping the treatment usually helps to bring them under control. Treatment can then be resumed, possibly using a lower dose of medication. Read about the complications of chronic myeloid leukaemia for more information and advice about being vulnerable to infection and bleeding. Treating advanced chronic myeloid leukaemia Chemotherapy Once chronic myeloid leukaemia has progressed toa more advanced stage, chemotherapy is the next treatment. Chemotherapy tablets are usually used first because they have fewer and milder side effects than chemotherapy injections. Side effects include: tiredness skin rash increased vulnerability to infection Chemotherapy can weaken your immune system, which helps protect you against infection. This is known as being immunocompromised. Read chronic leukaemia complications for more information about this. If your symptoms persist or get worse, chemotherapy injections (intravenous chemotherapy) will need to be used. Intravenous chemotherapy causes more side effects than chemotherapy tablets and they tend to be more severe. Side effects include: nausea vomiting tiredness hair loss infertility These side effects should resolve after your treatment has finished, although there is a risk that infertility could be permanent. Bone marrow and stem cell transplants A bone marrow transplant can offer a cure forchronic leukaemia, although it is only suitable and necessaryforsome patients. Before transplantation can take place, the person receiving the transplant has to have aggressive, high-dose chemotherapy and radiotherapy to destroy any cancerous cells in their body. This can put enormous strain on the body and can cause significant side effects and potential complications. Transplantations have better outcomes if the donor has the same tissue type as the person who is receiving the donation. The best candidate to provide a donation is usually a brother or sister with the same tissue type. Due to these issues, transplantations are usually only successful when they are carried out in children and young people, or older people in good health, and there is a suitable brother or sister who can provide a donation. In most cases of chronic leukaemia, the potential risks of transplantation far outweigh any benefit. However, your specific circumstances may mean that the benefits of treatment outweigh the risks. Read more about bone marrow transplants Complications of chronic myeloid leukaemia Being immunocompromised (having a weakened immune system) is a possible complication for some patients with chronic leukaemia. There are 2 reasons for this: the lack of healthy white blood cells means your immune system is less able to fight infection many of the medicines used to treat chronic leukaemiacan weaken the immune system This means you are more vulnerable to developing an infection, and that any infection you have has an increased potential to cause serious complications. You may be advised to take regular doses of antibiotics to prevent infections from occurring. You should immediately report any possible symptoms of an infection to your GP orcare teambecause prompt treatment may be required to prevent serious complications. Symptoms of infection include: high temperature (fever) of 38C (101.4F) or above headache aching muscles diarrhoea tiredness Avoid contact with anyone who is known to have an infection, even if it is a type of infection that you were previously immune to, such as chickenpox or measles. This is because your previous immunity to these conditions will probably be suppressed (lowered). While it is important to go outside on a regular basis, both for exercise and for your psychological wellbeing, avoid visiting crowded places and using public transport during rush hour. Also ensure that all of your vaccinations are up-to-date. Your GP or care team will be able to advise you about this. You will be unable to have any vaccine that contains activated particles of viruses or bacteria, such as: themumps, measles and rubella (MMR) vaccine the polio vaccine the oral typhoid vaccine the BCG vaccine (used to vaccinate against tuberculosis) the yellow fever vaccine Psychological effects of chronic leukaemia Receiving a diagnosis of chronic leukaemia can be very distressing, particularly if it is unlikely that your condition can be cured. At first, the news may be difficult to take in. The situation can be made worse if you are confronted with the knowledge that even though your leukaemia may not currently be causing any symptoms, it could be a serious problem in later life. Having to wait many years to see how the leukaemia develops can be immensely stressful and can trigger feelings of stress, anxiety and depression . If you have been diagnosed with leukaemia, talking to a counsellor or psychiatrist (a doctor who specialises in treating mental health conditions) may help you to combat feelings of depression and anxiety. Antidepressants or medicines that help to reduce feelings of anxiety may also help you cope better with the condition. You may find it useful to talk to other people who are living with leukaemia. Your GP or multidisciplinary team may be able to provide you with details of local support groups. Another excellent resource is Macmillan Cancer Support . Their helpline number is 0808 808 00 00 and is open Monday to Friday, 9am-8pm. Further information You can read more information from Cancer Research UK about coping with chronic myeloid leukaemia . Source: NHS 24 - Opens in new browser window Last updated: 13 November 2023 How can we improve this page? 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