Chronic myeloid leukemia
Chronic myeloid leukemia
Introduction
Tissues of the marrow are called as myeloid. Such tissues are mainly cells of your blood. Chronic myeloid leukemia is a tumorous condition that affects the myeloid. When cells in these tissues experience rapid multiplication, they can disturb the normal cells in your bloodstream. These cancers – not in all cases – are known to spread over to brain, skin as well as mouth. As these conditions can spread in a very short span of time, leaving it untreated can make it a serious problem.
Medical science has identified a large number of risk factors that trigger chronic myeloid leukemia. Of the several risks, frequent use of tobacco, environmental hazards like being exposed to benzene rings, becoming old, earlier treatment of chemotherapy and / or radiations may cause this form of cancer. In general, men are more vulnerable to these types of cancers than women
Chronic myeloid leukemia ICD 10
Marrow is the place – present in your bones – where cells of blood are produced. Chronic myeloid leukemia is a very rare-kind of tumor that shows up in your marrow. It causes a remarkable-increase in white-cells of your blood. This condition is labelled a ‘chronic’ as it grows very-slowly when compared to other acute-versions of leukemia.
Prognosis of patients living with chronic myeloid leukemia has improved with clinical breakthroughs in its treatment. It is now possible to move to remission, and also to extend your lifespan for several years. As per ICD 10, the term ‘myeloid’ indicates the kind of cells that are impacted by this cancerous condition. It is also labelled as the ‘chronic granulocytic’ version of leukemia under ICD 10.
This form of cancer is more common among elderly-people, and is quite a rare-thing among younger adults, teens and children. However, you need to know that chronic myeloid leukemia can show up in people of all age-groups.
What is chronic myeloid leukemia?
This is a cancer of white cells in blood; it is affected by an uncontrolled-multiplication of the myeloid-genre of cells in marrow. This unregulated-growth causes a significant build-up of white cells. Recent innovations in targeted-therapy – especially, discovery of tyrosine-kinase inhibiting-meds – has resulted in higher survival-rates among patients. These inhibitors are considered a breakthrough, allowing patients to have healthy quality of living – as compared to earlier generations of chemo-meds.
In the developed world, i.e., western nations, share of chronic myeloid leukemia is > 22% of all forms of leukemia in adults. If you include pediatric patients, chronic version of myeloid leukemia accounts for 14% of all forms of leukemia.
This form of cancers is common among men than in women. Data reveal an incidence-ratio of nearly 1.4 males to 1 female i.e., ~1.4:1. In terms of age-group, average age of diagnosis hovers at 64-years. Being exposed to radiations of the ionising-genre is one significant health-risk.
For instance, people who survived Nagasaki and Hiroshima nuclear bombs saw a 45-fold increase in risks of getting chronic myeloid leukemia. Studies done among such people show its onset had peaked in 9 years’ time after being exposed to nuclear radiations.
Chronic myeloid leukemia is usually diagnosed through the count of blood cells. It is suspected when there is a marked increase in granulocytes – of all genres. These cells are essentially of myeloid-type, and are relatively matured. Your treating oncologist will order a biopsy of your marrow to confirm its incidence.
This chronic condition is sub-divided into 3 distinctive phases, based on clinical-traits and lab-based investigations. These 3 phases are 1- chronic phase, 2- accelerated phase and 3- blast phase. Of these, blast phase is labelled as a crisis, and is also considered as final stage of chronic myeloid leukemia.
At the blast phase, this chronic condition starts behaving as an acute condition. Medical science has evidences linked to occurrence of newer abnormalities in chromosomes as a prerequisite for this condition to turn severe. A few people have been diagnosed at an accelerated or blast phase, showing the advanced level of progression of this condition.
As high as 3/4th of people living with chronic myeloid leukemia are diagnosed at the chronic-stage of this autoimmune condition. Being the 1st stage, you are unlikely to witness symptoms; at best, you may witness milder signs like being tired, fullness of tummy, pains on the left-side of body, painful joints or hip, etc.
Timeline of 1st phase is subjective to how soon this condition is detected, and on the kind of prior therapies administered to you. If you decide to leave this untreated, the chronic stage worsens into an accelerated phase. Your caregiving team may order for genomic-profiling or clinical marking of tumors to assess risks of rapid progression.
Diagnosis of transition from chronic to the accelerated phase is also a subjective thing. World Health Organisation has issued a set of criteria to define accelerated phase of chronic myeloid leukemia. These include > 20% basophils in your peripheral bloodstream; a consistent increase in white cells of blood i.e., greater than 10X 10^9 / L and remains unresponsive to therapies. Must you have condition that ticks any of these aforesaid boxes it is then labelled as an accelerated stage.
Once your autoimmune condition transitions into an accelerated mode, it means a blast is quite imminent. This also means drugs will turn ineffective to treat this phase of your cancerous condition. At the blast phase, it is often a crisis and it soon turns into an acute condition. As per WHO, this crisis is characterised by > 19% blast in your marrow or blood
Chronic myeloid leukemia symptoms
Typical signs of chronic myeloid leukemia are very vague. These can be quite confusing as a few other conditions also show-up through same signs. Also, signs of this form of leukemia do not change with gender; both females and males tend to witness same symptoms.
Common symptoms of chronic myeloid leukemia are: inexplicable increase in weight, increase in body temperature, nighttime sweating, painful bones – triggered by spread of cancer cells from your marrow to surface of your bones, enlargement of your spleen – your can feel a mass underneath the lefthand side of your ribcage, etc.
Caveat: These are not signs typical of chronic myeloid leukemia alone; many other types of cancers and also, a few non-cancerous conditions show-up through such symptoms. Hence, it takes a discerning-eye of an oncologist to tell the signs apart
Chronic myeloid leukemia treatment
Treating chronic myeloid leukemia – with a curative intent – is through stem-cell transplantation or transplantation of marrow. Apart from these, oncologists administer tyrosine kinase inhibiting meds and myelosuppressive therapies. In the chronic stage, oncologists had administered alkylating meds, steroidal drugs and anti-metabolites like hydroxyurea. Advent of tyrosine inhibiting drugs in mid-2001 changed the way chronic stage of leukemia is treated. However, in some cases, drugs like antimetabolites – especially, hydroxyurea continue to be administered to patients of chronic myeloid leukemia.
Among the newer generation of meds, drugs like imatinib are known to successfully block the worsening of this form of cancers. Some people may develop resistance to imatinib. In order to overcome it, drugs such as nilotinib, bosutinib etc., are widely used. All such meds have the needful clearance of the food & drug administration – FDA. By 2022, use of bosutinib has gained traction in US along with nilotinib.
Prior to discovery of tyrosine kinase inhibiting meds, the average timeline of survival among cancer patients was ~ 4 years. But with the administration of tyrosine kinase inhibitors, rates of survival have increased in a significant manner. A clinical study done on cancer patients – taking imatinib – showed 85% of people survived after 4 years of such treatment. In a follow-up study done on people taking imatinib, the rates of survival increased to more than 95% after 7 years.
In sum, as no symptoms are visible during initial phases of chronic myeloid leukemia, diagnosis are accidently done off a normal lab-test. Diagnosis was also possible by observing pains felt on left side of your body. Enlargement of your spleen can exert an added pressure on to your tummy; this can cause a sudden loss of your body weight as an outcome of a decreased appetite level.
Due to an increased level of metabolism, you tend to experience (profuse) sweating and a mild increase in body temperature. Regardless of the above, chronic phase is best diagnosed by an elevated count of white cells in blood. It indeed remains the most-distinguishing symptom of this form of leukemia. For more details on treatment of chronic myeloid leukemia, talk to your oncologist.
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Education: Master of Public Health (MPH) from the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh Experience: A dedicated health writer with 8 years of experience covering a range of health topics, including public health and nutrition. His work has appeared on reputable Indian health websites and journals such as India Health Journal and The Health Times. Ravi also collaborates with Indian health agencies on public health campaigns.