CML (Chronic Myelocytic Leukemia/ Chronic Granulocytic Leukemia

In the last post, i wrote about Acute Myelocytic Leukemia. Now i post my new article about Chronic Myelocytic Leukemia.

CML cell

What is Chronic Myelocytic Leukemia?

Chronic Myelocytic Leukemia commonly called CML. The sell type which affected this cancer is granulocytic Leukocyte so called Chronic Granulocytic Leukemia. The term “chronic” indicates that this cancer tends to progress more slowly than acute forms of Leukemia. Its characterized by the increased and unregulated growth of predominantly myeloid cells (granulocyte blast) in bone marrow and accumulation of these cells in blood.

Pathology

There is a switch in pieces of chromosome 22 and 9. This translocation takes place in a single bone marrow cell and, through the process of clonal expansion. The break on chromosome 22 involves a gene called “BCR” and the break on chromosome 9 involves a gene called “ABL”. Apiece of chromosome 9 attaches to the end of chromosome 22 and the BCR-ABL cancer gene is made. The BCR-ABL cancer gene gives the cell instructions to make a protein that leads to CML The breaking off of chromosome 22 makes abnormal chromosome wich called Philadelphia chromosome. The Philadelphia chromosome produces tyrone kinase wich is responsible for the abnormal growth pattern of leukocyte in CML. Philadelphia chromosome is the mark of CML.

Translocation material between chromosome 9 and 22

Pathophysiology

CML can have three phases:

1. The Chronic desease
2. The accelerated phase
3. The blast crisis phase

During chronic phase, CML symptoms are less intense. Almost blood components can do their jobs normally. In the accelerated phase, the leukocyte number may go up or go down, erytrocyte and trombocyte number may drop. So in this phase patients can develop anemia. IN the blast crisis, we can find signs and symptoms example: spleenomegaly, increasing of blast cell, the number of erytrocyte and trombocyte drops wich make the patients look tired, dyspneu, abdominal and bone pain, also bleeding.

What are sign and symptoms of CML?

1. tired and weakness
2. fever
3. easy bleeding
4. frequent infections
5. Losing weight without trying
6. spleenomegaly
7. pain
8. Philadelphia chromosome sign

How to diagnosis CML?

The diagnosis of CML is suspected based on the result of a simple blood test. The test blood cell shows more immature white blood cell. Bone marrow aspirate and a bone marrow biopsy are two test that are done to look at the marrow cells for changes that can not be seen in cells blood. Philadelphia chromosome is detected by analyzes chromosome test.

How to treat patient of CML?

The treatment options depend on the following:

1. patient’s age and general health
2. the phase of CML
3. the amount of blasts in the blood or bone marrow
4. the size of the spleen

there are six types of standard treatment are used:

1. Imanitib mesylate and dasatinib: these drugs used initial treatment for certain types of CML in newly diagnosed patient. they block tyrosine kinase wich produced by Philadelphia chromosome. Tyrosine kinase is enzyme that causes stem cell to develop into granulocyte cell than the body needs.
2. Chemotherapy: using drugs to stop the growth of cancer celll
3. Biologic therapy is e treatment that uses the patient’s immune system to fidght cancer
4. Stem cell transplant: used during blast crisis
5. DLI (Donor lymphocyte Infusion)
6. Splenectomy: surgery to remove spleen

What are risk factors of CML

1. Very high level radiation
2. High dose radiation therapy used to treat other cancers

Attention!!! There is no link between dental or medical x-rays and increased risk of CML.

Epidemiology

Most of patients CML are adult.

refferences:

1. www.medterms.com

2. www.cancer.gov

3. www.merck.com

4. www.nlm.nih.gov