6/26/2018 Chronic Myelogenous Leukemia Treatment (PDQ®)—Patient Version - National Cancer Institute

Chronic Myelogenous Leukemia Treatment (PDQ®)–Patient

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General Information About Chronic Myelogenous Leukemia

KEY POINTS

• Chronic myelogenous leukemia is a disease in which the bone marrow makes too many white blood cells.
• Leukemia may affect red blood cells, white blood cells, and platelets.
• Signs and symptoms of chronic myelogenous leukemia include fever, night sweats, and tiredness.
• Most people with CML have a gene mutation (change) called the Philadelphia chromosome.
• Tests that examine the blood and bone marrow are used to detect (find) and diagnose chronic
myelogenous leukemia.
• Certain factors affect prognosis (chance of recovery) and treatment options.

Chronic myelogenous leukemia is a disease in which the bone marrow makes too
many white blood cells.
Chronic myelogenous leukemia (also called CML or chronic granulocytic leukemia) is a slowly progressing blood
and bone marrow disease that usually occurs during or after middle age, and rarely occurs in children.

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Anatomy of the bone. The bone is made up of compact bone, spongy

bone, and bone marrow. Compact bone makes up the outer layer of the
bone. Spongy bone is found mostly at the ends of bones and contains red
marrow. Bone marrow is found in the center of most bones and has many
blood vessels. There are two types of bone marrow: red and yellow. Red
marrow contains blood stem cells that can become red blood cells, white
blood cells, or platelets. Yellow marrow is made mostly of fat.

Leukemia may affect red blood cells, white blood cells, and platelets.
Normally, the bone marrow makes blood stem cells (immature cells) that become mature blood cells over time.
A blood stem cell may become a myeloid stem cell or a lymphoid stem cell. A lymphoid stem cell becomes a
white blood cell.

A myeloid stem cell becomes one of three types of mature blood cells:

• Red blood cells that carry oxygen and other substances to all tissues of the body.
• Platelets that form blood clots to stop bleeding.
• Granulocytes (white blood cells) that fight infection and disease.
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Blood cell development. A blood stem cell goes through several steps to
become a red blood cell, platelet, or white blood cell.

In CML, too many blood stem cells become a type of white blood cell called granulocytes. These granulocytes are
abnormal and do not become healthy white blood cells. They are also called leukemia cells. The leukemia cells
can build up in the blood and bone marrow so there is less room for healthy white blood cells, red blood cells,
and platelets. When this happens, infection, anemia, or easy bleeding may occur.

This summary is about chronic myelogenous leukemia. See the following PDQ summaries for more information
about leukemia:

• Adult Acute Lymphoblastic Leukemia Treatment

• Childhood Acute Lymphoblastic Leukemia Treatment
• Adult Acute Myeloid Leukemia Treatment
• Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment
• Chronic Lymphocytic Leukemia Treatment
• Hairy Cell Leukemia Treatment

Signs and symptoms of chronic myelogenous leukemia include fever, night sweats,
and tiredness.
These and other signs and symptoms may be caused by CML or by other conditions. Check with your doctor if
you have any of the following:

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• Feeling very tired.

• Weight loss for no known reason.
• Night sweats.
• Fever.
• Pain or a feeling of fullness below the ribs on the left side.

Sometimes CML does not cause any symptoms at all.

Most people with CML have a gene mutation (change) called the Philadelphia
chromosome.
Every cell in the body contains DNA (genetic material) that determines how the cell looks and acts. DNA is
contained inside chromosomes. In CML, part of the DNA from one chromosome moves to another chromosome.
This change is called the “ Philadelphia chromosome.” It results in the bone marrow making an enzyme, called
tyrosine kinase, that causes too many stem cells to become white blood cells (granulocytes or blasts).

The Philadelphia chromosome is not passed from parent to child.

Philadelphia chromosome. A piece of chromosome 9 and a piece of

chromosome 22 break off and trade places. The bcr-abl gene is formed on
chromosome 22 where the piece of chromosome 9 attaches. The changed
chromosome 22 is called the Philadelphia chromosome.

Tests that examine the blood and bone marrow are used to detect (find) and
diagnose chronic myelogenous leukemia.
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The following tests and procedures may be used:

• Physical exam and history : An exam of the body to check general signs of health, including checking for
signs of disease such as an enlarged spleen. A history of the patient’s health habits and past illnesses and
treatments will also be taken.
• Complete blood count (CBC) with differential : A procedure in which a sample of blood is drawn and
checked for the following:
• The number of red blood cells and platelets.
• The number and type of white blood cells.
• The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
• The portion of the blood sample made up of red blood cells.

Complete blood count (CBC). Blood is collected by inserting a needle

into a vein and allowing the blood to flow into a tube. The blood sample
is sent to the laboratory and the red blood cells, white blood cells, and
platelets are counted. The CBC is used to test for, diagnose, and
monitor many different conditions.

• Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of
certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower
than normal) amount of a substance can be a sign of disease.
• Bone marrow aspiration and biopsy : The removal of bone marrow, blood, and a small piece of bone by
inserting a needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone

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under a microscope to look for abnormal cells.

Bone marrow aspiration and biopsy. After a small area of skin is

numbed, a bone marrow needle is inserted into the patient’s hip bone.
Samples of blood, bone, and bone marrow are removed for
examination under a microscope.

One of the following tests may be done on the samples of blood or bone marrow tissue that are removed:

• Cytogenetic analysis: A test in which cells in a sample of blood or bone marrow are viewed under a
microscope to look for certain changes in the chromosomes, such as the Philadelphia chromosome.
• FISH (fluorescence in situ hybridization): A laboratory technique used to look at genes or
chromosomes in cells and tissues. Pieces of DNA that contain a fluorescent dye are made in the
laboratory and added to cells or tissues on a glass slide. When these pieces of DNA bind to specific
genes or areas of chromosomes on the slide, they light up when viewed under a microscope with a
special light.
• Reverse transcription–polymerase chain reaction (RT–PCR): A laboratory test in which cells in a
sample of tissue are studied using chemicals to look for certain changes in the structure or function of
genes.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

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• The patient’s age.

• The phase of CML.
• The amount of blasts in the blood or bone marrow.
• The size of the spleen at diagnosis.
• The patient’s general health.

Updated: May 18, 2018

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