Chronic myeloid leukemia (CML) is a type of cancer that affects blood-forming tissues. With appropriate treatment, it is possible for people with CML to experience remission.
Most individuals who experience CML develop this condition when they become middle-aged. This form of leukemia causes blood cells to develop atypically. These atypical cells can spread throughout the body and cause symptoms such as bleeding and infections.
In the 1970s, the 5-year survival rate for CML was
This article discusses what CML is, its causes, symptoms, and how doctors treat it. We explore the latest research on CML remission.
Leukemia is a type of cancer that targets blood and forms in bone marrow, the tissue found inside bones. Bone marrow
In CML, bone marrow overproduces certain types of blood cells, such as granulocytes and blasts, which are immature granulocytes. These blasts take up too much space in the bone marrow and hinder the bone marrow’s ability to create healthy blood cells.
Blast cells spread throughout the body via the bloodstream. This process causes side effects such as anemia and excess bleeding.
Researchers divide CML into three phases:
- Chronic: This phase involves a small number of blasts and few symptoms.
- Accelerated: In this phase, blasts grow in number and can begin to travel throughout the body.
- Blast: During this phase, the number of blast cells in the bone marrow and bloodstream grows sharply.
The blast, or blast crisis, phase is the most dangerous phase of CML. Fortunately, most people with the condition receive a diagnosis in the chronic phase, which increases their likelihood of a full recovery.
A genetic mutation, called a translocation,
In people with CML, DNA transfers between chromosomes 9 and 22. This creates a shorter form of chromosome 22 than in typically healthy cells.
Scientists refer to this atypical chromosome as the Philadelphia chromosome, which is observable in virtually all people with CML. This genetic mutation creates an oncogene, BCR-ABL. The BCR-ABL gene produces a protein that makes the bone marrow produce the blast cells associated with CML.
CML can also develop without the Philidelphia chromosome. In this case, the BCR-ABL oncogene may form differently. However, some people with CML do not have the Philidelphia chromosome or BCR-ABL gene. In this case, a different oncogene may cause CML.
The symptoms of CML vary according to the individual and what phase they are experiencing. Some of the most common symptoms include:
- unexplained tiredness
- sweating at night
- pain in the abdominal area
- feelings of weakness
- unexpected weight loss
In most cases, people who develop CML are over the age of 60 years. These individuals may also experience anemia, appetite loss, or fever.
However, many people with CML do not experience symptoms during the chronic phase. The symptoms become more pronounced in the advanced phases of CML.
The type of treatment doctors use to treat CML depends on the phase of the disease. Several of the main
In the chronic phase, the standard CML treatment involves tyrosine kinase inhibitors (TKIs). These medications work by blocking the action of enzymes called tyrosine kinases.
Tyrosine kinases have a role in cell development — if they mutate, they may cause stem cells to develop into blasts. Blocking these enzymes can reduce the number of blasts in the body to treat CML in the chronic phase.
In the accelerated phase, people with CML may take TKIs if they have not yet received CML treatment. If they have already taken TKIs, they may begin to take a larger dose or switch to a different type of TKI. Some people may also receive chemotherapy or a stem cell transplant.
The blast phase of CML is more difficult to treat. Individuals with CML in this phase may continue to receive TKIs and chemotherapy. They may also receive radiation therapy or a stem cell transplant.
The best treatment for CML depends on the individual and their disease stage. People with CML should consult with a medical professional to learn more about which option would be most effective for their individual case.
The goal of modern CML treatment is to achieve treatment-free remission (TFR). According to research, about 40–60% of people who end TKI therapy remain in remission.
To attempt TFR, people with CML must first take TKIs for at least 3 years and show a strong response to this treatment for at least 2 years. Eligible individuals who fulfill these requirements could stop taking TKI treatment under a doctor’s guidance.
The National Comprehensive Cancer Network recommends that people with CML stop TKI therapy if they meet eligibility requirements and consent to attempt TFR. However, the side effects relating to CML treatment can be debilitating. Achieving TFR means that a person does not have to experience further side effects.
Between
Individuals who respond well to TKI therapy for a long period are suitable candidates for achieving TFR. Anyone interested in achieving CML remission should speak with a doctor to determine when and how stopping TKI treatment might work for them.
The survival rates for CML today are higher than they have ever been. One study found that
However, the outlook for those with the condition depends on a complicated set of factors. Some factors that may negatively affect recovery include:
- having an advanced stage of CML
- being over 60 years of age
- having an enlarged spleen
- having an atypical platelet count
- having a high number of blasts
- the presence of anemia at diagnosis
However, the presence of some or all of these factors does not guarantee a negative outlook. With current treatments, most people with CML can achieve remission.
However, only a medical professional can provide accurate information surrounding remission and recovery for each individual. A person with CML should work closely with a doctor to learn more about the possibilities of remission in their individual case.
People with CML receive a range of treatments depending on their phase of the condition. In many cases, these individuals can achieve remission.
Although many treatment options are available, the right treatment is different for each person. Treatment in the early stages of CML is the optimal route to recovery.
Under the guidance of a qualified medical team, people with CML can receive early and effective treatment. A person with CML should speak with a healthcare professional about treatment options and the possibility of remission.