OVERVIEW

What is chronic myeloid leukemia?

Chronic myeloid leukemia (CML), also known as chronic myelogenous leukemia, is a malignant tumor of the hematopoietic system (leukemia) associated with chromosomal abnormalities. Symptoms include fatigue, weight loss, fever, and splenomegaly. It is more common in middle-aged and elderly patients.

In terms of treatment, long-term oral administration of tyrosine kinase inhibitors (TKIs) can effectively control the disease and significantly prolong patients' lifespans. Additionally, bone marrow transplantation may also be performed.

Patients with chronic myeloid leukemia not only endure physical suffering but may also experience negative emotions psychologically. However, no matter what, please do not lose hope in treatment.

If a family member or friend is diagnosed with chronic myeloid leukemia, please provide them with sufficient emotional support and encourage them to actively pursue treatment.

Is chronic myeloid leukemia common?

Chronic myeloid leukemia is not common, with an annual incidence rate of 1 per 100,000 people, accounting for 15% of adult leukemia cases.

SYMPTOMS

What are the manifestations of chronic myeloid leukemia?

Early stages often show no symptoms, but may present with common discomforts such as fatigue, weakness, reduced appetite, weight loss, fever, night sweats, or abdominal fullness (medical consultation is advised to determine the cause). Splenomegaly may also be detected.

As the disease progresses, spleen enlargement worsens, accompanied by pale skin and bleeding, which may include fever, swollen lymph nodes, and skin bruising.

85% of patients are in the chronic phase. Without effective treatment, the condition may progress to an unstable accelerated phase and eventually transform into a blast crisis.

CAUSES

What are the causes of chronic myeloid leukemia?

It is related to chromosomal abnormalities. Most patients have the Philadelphia chromosome, where a translocation occurs between chromosomes 9 and 22, forming the bcr/abl fusion gene.

Is chronic myeloid leukemia hereditary?

Leukemia is closely related to genetic factors, but genetics is not the sole cause. Environmental factors also play a role. In other words, if a family member has leukemia, the risk of developing the disease is higher than in the general population, but it is not guaranteed.

Who is affected by chronic myeloid leukemia?

It can occur at any age, but most cases are in middle-aged and elderly individuals. It is rare in those under 10 years old, and males are slightly more affected than females.

DIAGNOSIS

What tests are needed to diagnose chronic myeloid leukemia?

Tests such as complete blood count, blood smear, bone marrow aspiration, and cytogenetic examination (related chromosomes) are required.

The most critical diagnostic basis is the results of blood smear and bone marrow aspiration, not the detection of the Philadelphia chromosome or BCR-ABL1 fusion gene.

When diagnosed with chronic myeloid leukemia, anyone may find it hard to accept, and some may even have extreme thoughts. Others may blame themselves, feeling they have burdened their families. At this moment, family and friends must provide patients with sufficient support and companionship, face it together with them, help them adjust their mindset, and quickly engage in treatment.

Which diseases can chronic myeloid leukemia be easily confused with?

It may resemble conditions like leukemoid reaction and requires differentiation.

TREATMENT

Which department should I visit for chronic myeloid leukemia?

Hematology department.

How is chronic myeloid leukemia treated?

• The first-line treatment is tyrosine kinase inhibitors (TKIs). Long-term oral administration can achieve significant remission and even a normal lifespan. For patients who cannot use TKIs, interferon-based therapy or allogeneic hematopoietic stem cell transplantation may be considered.
• Hydroxyurea, which is still commonly used, only controls blood counts and offers no benefits for disease remission or long-term survival. Domestic TKI drugs can reduce financial burdens, so TKI treatment should be prioritized whenever possible.
• Hematopoietic stem cell transplantation is another option and may lead to a cure.

Which chronic myeloid leukemia patients are eligible for hematopoietic stem cell transplantation (bone marrow transplantation)?

Due to the excellent overall efficacy of TKI drugs, allogeneic hematopoietic stem cell transplantation is generally reserved for cases of TKI treatment failure or intolerance, or for patients with T315I mutations and rapid disease progression.

While hematopoietic stem cell transplantation may cure the disease, it can also lead to complications and death, so it is no longer considered first-line treatment for chronic myeloid leukemia.

How long is TKI treatment needed for chronic myeloid leukemia? When can it be discontinued?

Treatment efficacy is typically assessed after one month of medication, and long-term use is often required. Discontinuation is still under experimental investigation, and continued adherence is generally recommended during treatment.

What are the long-term side effects of medication for chronic myeloid leukemia patients?

• Anemia and thrombocytopenia, with a risk of severe bleeding;
• Severe rashes and liver toxicity;
• Fatigue and weakness;
• Some drugs have cardiac toxicity, requiring special monitoring for patients with a history of heart disease;
• Imatinib and dasatinib may help control blood sugar, while nilotinib may worsen it.

Do chronic myeloid leukemia patients need follow-up examinations?

Long-term follow-up is necessary to monitor treatment efficacy and side effects, including blood tests and chromosomal examinations. The frequency of follow-ups depends on the patient's condition.

Is chronic myeloid leukemia prone to relapse?

With regular TKI medication, the disease can now be well controlled, and relapse is rare.

Patients should avoid other medications or herbal supplements that may interfere with TKI efficacy.

Is chronic myeloid leukemia a terminal illness?

Advances in TKI treatment have significantly extended the lifespan of patients, and it is no longer considered a terminal or severe disease.

DIET & LIFESTYLE

What should chronic myeloid leukemia patients pay attention to in daily life and diet?

Different stages require different considerations:

• At the onset of the disease or during initial treatment, when the tumor burden is high, patients should monitor drug efficacy and side effects. It is important to drink plenty of water, urinate frequently, and, if necessary, use urine-alkalizing medications and drugs to aid uric acid excretion. Reduce intake of high-purine foods.
• During the stable remission phase, daily life and diet can be similar to those of healthy individuals.
• In the advanced or severe stages, precautions should be taken to avoid infections and overexertion. If platelet counts are low, physical activity should be reduced to minimize the risk of bleeding.
• During medication, be cautious with the use of other drugs or herbal supplements, as they may interfere with the efficacy of TKIs.
• Can chronic myeloid leukemia patients work during treatment?
• Most patients in the chronic phase can work moderately while avoiding excessive fatigue.

Does chronic myeloid leukemia affect fertility?

The disease itself has little impact on fertility, but medication can affect the fetus. Women taking imatinib are advised against pregnancy and breastfeeding, as the drug may cause fetal malformations.

Discontinuing medication for pregnancy is not recommended, as it may lead to disease relapse in patients who have achieved remission.

PREVENTION

How to Prevent Chronic Myeloid Leukemia?

Since the exact cause of chronic myeloid leukemia is unclear, there is no highly effective prevention method. However, avoiding various carcinogenic factors (such as ionizing radiation and harmful chemicals) in daily life may help reduce the risk of developing granulocytic leukemia.