Hematologic Malignancies Program

Chronic Myelogenous Leukemia

What is Chronic Myelogenous Leukemia? | Symptoms | Stages and Treatments | About the Cinical Trials | Greenebaum Cancer Center

Stages and Treatments

To make or confirm a diagnosis of chronic myelogenous leukemia, the doctor must do a review of blood tests and a genetic analysis of the blood and bone marrow.

The stages of and treatments for chronic myelogenous leukemia:

Chronic phase: There are few blast cells in the blood and bone marrow and there may be no symptoms of leukemia. This phase may last from several months to several years. Treatment may be one of the following:

Accelerated phase: There are more blast cells in the blood and bone marrow and fewer normal cells. Treatment during this phase may be the same as is given in the chronic phase, but chemotherapy may be more aggressive.

Blastic phase: More than 30 percent of the cells in the blood or bone marrow are blast cells. The blast phase of chronic myelogenous leukemia is sometimes called "blast crisis." Sometimes blast cells will form tumors outside of the bone marrow in places such as the bone, skin, lungs, brain, or lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. Treatment may be one of the following:

For meningeal chronic myelogenous leukemia, treatment may be one of the following:

Treatment Options

There are three primary treatments for patients with chronic myelogenous leukemia:

  1. chemotherapy
  2. radiation therapy
  3. stem cell transplantation

The use of biological therapy is being tested in clinical trials. In rare cases, surgery may be performed to remove the spleen (splenectomy).

Side effects can occur with cancer treatments because healthy cells are often damaged along with cancer cells. The type and extent of these side effects vary depending on the particular treatment involved, its duration, and its dose.

See related article on Chronic myelogenous leukemia

Chemotherapy

Imatinib (Gleevec) is the first line of therapy for all patients. Gleevec blocks the Philadelphia chromosome and is assosicated with very high rates of remission. Similar drugs are being developed.

Sometimes a chemotherapy medicine called hydroxyurea (Hydrea) is used temporarily to control the white blood cell count.

Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. It is generally given in cycles: a treatment period is followed by a recovery period, then another treatment period, and so on.

Chemotherapy drugs generally target rapidly dividing cancer cells. However, other cells that also divide rapidly include blood cells, cells that line the digestive tract, and cells in hair follicles. Unfortunately, these healthy cells may also be impacted by the chemotherapy drugs, resulting in side effects such as infections, tiredness, temporary hair loss, mouth sores, and other symptoms. Not all chemotherapy patients develop all of these symptoms, and they usually go away during the recovery period or after treatment stops. Medicines and other treatments are available to control or minimize many of these symptoms.

Radiation therapy

Radiation is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation for chronic lymphocytic leukemia usually comes from a machine outside the body (external radiation therapy). The most common side effects of radiation therapy are tiredness, skin reactions in the treated areas (such as a rash or redness), and loss of appetite. Radiation therapy may also cause a decrease in the number of white blood cells that help protect the body against infection. Most of these side effects can be treated or controlled and in most cases they are not permanent.

Stem cell transplantation

Stem cell transplantation is a treatment in which a patient's diseased bone marrow is replaced with healthy stem cells to repopulate the marrow. There are two main types of transplants:

Allogeneic transplant: A transplant using marrow from a relative or person not related to the patient is called an allogeneic transplant. Allogeneic transplants may be done using either a standard high-dose therapy or a less toxic, nonablative, immunosuppressive therapy.

In the standard high-dose therapy approach, all of the bone marrow in the body is destroyed with high doses of chemotherapy with or without radiation therapy. Healthy marrow or blood stem cells are then taken from another person (a donor) whose tissue is the same or almost the same as that of the patient. The donor may be a twin (the best match), a brother or sister, or a person who is not related. The healthy stem cells from the donor are then transferred to the patient through a needle in the vein, and the new marrow replaces the original marrow that was destroyed.

In a nonmyeloablative transplant, the goal is not to destroy the patient's marrow but to allow for the donor cells to take hold or "engraft." In this type of transplant, less intensive medications are used and the marrow is not completely destroyed prior to the transplant.

Autologous transplant: Another type of bone marrow transplant, called an autologous bone marrow transplant, is being studied in clinical trials. In this type of transplant, blood stem cells are taken from the patient after treatment with drugs to kill cancer cells. The stem cells that were taken from the patient are then frozen and stored. Next, high-dose chemotherapy is given to the patient with or without radiation therapy to destroy the remaining leukemia cells. The frozen stem cells are then thawed and given back to the patient through a needle in a vein to repopulate the marrow and make blood cells.

A greater chance for recovery occurs in hospitals that do more than five stem cell transplantations a year.

Biological therapy

Biological therapy tries to get the body to fight cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.


This page was last updated on: May 21, 2008.