Acute lymphoblastic leukaemia (ALL)

About Cancer > Acute lymphoblastic leukaemia (ALL)

Acute lymphoblastic leukaemia (ALL)

What is chronic myeloid leukaemia (CML)?

Chronic myeloid leukaemia (CML) is a cancer of the white blood cells. It starts to develop in blood stem cells in the bone marrow. It causes early white blood cells to become abnormal. CML usually develops very slowly. About 830 people in the UK are diagnosed with CML each year. It can affect people at any age, but it is more common as people get older. For many people, it can be well-controlled and it will not shorten their life. We have more information about other types of leukaemia.

How chronic myeloid leukaemia develops

All blood cells are made from blood stem cells. These are blood cells at the earliest stage of their development. Blood stem cells develop into the following 2 types:

Lymphoid stem cells make white blood cells called lymphocytes.
Myeloid stem cells make all the other types of blood cell. These include red blood cells, platelets and other white blood cells, such as neutrophils.

CML develops because of a genetic change in the stem cells. This change stops them developing into normal myeloid cells. We have more information about genes and chromosomes in chronic myeloid leukaemia (CML).

How blood cells divide

Symptoms of chronic myeloid leukaemia (CML)

Chronic myeloid leukaemia (CML) usually develops slowly. Many people do not have symptoms in the early stages. Sometimes CML is found by chance. This might be when someone has a blood test before an operation, or as part of a routine health check.
Sometimes in the early stages of CML, symptoms can be mild. They may be confused with the symptoms of more common illnesses, such as flu.
We have more information about general symptoms of leukaemia.

Causes of chronic myeloid leukaemia (CML)

Doctors do not know the exact causes of CML. But there are risk factors that can increase your chance of developing it.

Age

CML can develop at any age. But it is more common as people get older. Over half of people diagnosed with CML in the UK are over the age of 60.

Sex

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Radiation exposure

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Diagnosis of chronic myeloid leukaemia (CML)

If you have symptoms, you will usually begin by seeing your GP, who will examine you. If they think you may have chronic myeloid leukaemia (CML), they will refer you to a haematologist for further tests. A haematologist is a doctor who specialises in diagnosing and treating blood problems. The haematologist will ask you about any illnesses or health problems you have had. They will check if your spleen is enlarged and arrange tests. Tests may include:

Blood tests

You will have blood tests at the hospital. These tests will:

check the numbers of blood cells in your blood – this is called a full blood count (FBC)
look for leukaemia cells.

If there are leukaemia cells in your blood, the haematologist will arrange more tests. These will find what type of leukaemia you have and what phase it is. This will help your doctors plan your treatment.

Bone marrow biopsy

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Ultrasound scan

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Cytogenetic and molecular tests

Cytogenetic and molecular tests look for gene changes (mutations) inside the leukaemia cells. Tests may include:

Philadelphia chromosome test

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Polymerase chain reaction (PCR) test

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FISH testing

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Phases of chronic myeloid leukaemia (CML)

The treatment you have depends on the phase of chronic myeloid leukaemia (CML). CML usually develops slowly. The 3 phases of CML are the:

chronic phase
accelerated phase
blast phase.

Doctors know the phase of CML from:

the number of immature blood cells (blast cells) in your blood and bone marrow
your symptoms.

Most people are diagnosed when CML is in the chronic phase.

Chronic phase

When CML is in the chronic phase, there may be no symptoms. Most people can live a normal life. Treatment is tablets you can take at home. You have regular blood tests to check how well the treatment is working.
For most people, the leukaemia can be well controlled for as long as treatment continues.
In the chronic phase, less than 15 in 100 blood cells in the blood or bone marrow (15%) are blast cells.

Accelerated phase

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Blast phase

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Relapse

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Risk score of chronic myeloid leukaemia (CML)

As well as the phase of CML, your cancer doctor will calculate your risk score. This can help them to plan the best treatment for you.
Risk scores are based on:

your age
the size of your spleen
the number of blast
cells in your blood
your platelet count.

Depending on the risk score, people with CML can be grouped into 3 risk groups:

low
intermediate
high.

Knowing the risk group can give your haematologist an idea of how likely the CML is to respond well to treatment.
Most people with CML respond to tyrosine kinase inhibitor drugs (TKIs) regardless of their risk score.

Treatment for chronic myeloid leukaemia (CML)

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).
Your haematologist or specialist nurse will explain the different treatments and their side effects. They will also talk to you about things to consider when making treatment decisions. You will need this information before you give your permission (consent) to have any treatment.
The aim of treatment is to put CML into remission and keep it in remission. This means there are no signs of CML in your PCR blood test, and you feel well. There are different levels of remission.
Treatments may include:

Tyrosine Kinase Inhibitors (TKIs)

The main treatment for CML is with drugs called tyrosine kinase inhibitors (TKIs).

Chemotherapy

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Interferon alpha

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Leukapheresis

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Fertility and chronic myeloid leukaemia (CML) treatment

Some CML treatments may affect your fertility or harm a developing baby. Because of this you may be advised to use contraception to prevent a pregnancy. If you are worried about your fertility, it is important to talk with your doctor before you start treatment.

Living with CML

Follow-up and monitoring CML

If you have treatment with a tyrosine kinase inhibitor (TKI), you will be monitored by your healthcare team every 1 to 2 weeks. Your doctor will do a polymerase chain reaction (PCR) blood test to check for leukaemia cells every 3 months to start with. If you have a good response to TKI treatment, this may be done less often. Sometimes they may take a bone marrow sample. Your doctor can tell you how often you might need this. As time goes on, you may only need a check-up every 3 to 6 months. If you have another type of treatment, your doctor or nurse will tell you how often you will have appointments. If you have any problems or notice new symptoms between appointments, tell your doctor or specialist nurse.

Well-being and recovery

Most people with chronic myeloid leukaemia (CML) have a normal life expectancy. To help you stay as well as possible, you may want to make changes to your lifestyle. Even if you had a healthy lifestyle before your diagnosis, you may want to make the most of your health. A healthy lifestyle can help speed up your recovery. Even small lifestyle changes may improve your well-being and long-term health. Even if you already have a healthy lifestyle, you may choose to make some positive changes after treatment. We have more information on leading a healthy lifestyle after treatment.

Getting support

Everyone has their own way of dealing with illness and the different emotions they experience. You may find it helpful to talk things over with family and friends or your doctor or nurse. Macmillan is also here to support you. If you would like to talk, you can: Call the Macmillan Support Line for free on 0808 808 00 00. Chat to our specialists online. Visit our chronic myeloid leukaemia (CML) forum to talk with people who have been affected by chronic myeloid leukaemia (CML), share your experience, and ask an expert your questions.

Emergency Support

info@sabrcare.org

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Acute lymphoblastic leukaemia (ALL)