Chronic Myeloid Leukaemia

Overview

Chronic myeloid leukaemia (CML) is a rare cancer of the blood and bone marrow. Bone marrow is the spongy tissue inside bones where blood cells are made. In CML, a change in the DNA of a blood stem cell makes the body produce too many white blood cells, and these can build up over time. 'Chronic' means it usually grows slowly at first, and 'myeloid' describes the type of blood cell involved.

CML is uncommon. It is one of the less common types of leukaemia and is diagnosed in a small number of people each year.

CML mostly affects adults, especially middle-aged and older adults. It is rare in children. It affects slightly more men than women. Most people have no clear risk factors before diagnosis.

Symptoms

Common symptoms

• Feeling very tired or weak, even after rest
• Feeling full or bloated, especially under the left ribs, because the spleen can become enlarged
• Losing weight without trying
• Night sweats
• Fever or frequent infections
• Easy bruising or bleeding
• Bone or joint pain
• Many people have no symptoms at first and CML is found on a routine blood test

Symptoms in children

• CML is very rare in children, but when it happens symptoms can be similar to adults
• Tiredness or poor energy
• Frequent infections
• Easy bruising or bleeding
• Belly fullness or discomfort
• Bone pain

Symptoms in older adults

• Often no symptoms at first, and CML may be found on a blood test done for another reason
• Tiredness or breathlessness from low red blood cells (anaemia)
• Feeling full after small meals or discomfort under the left ribs
• Weight loss, night sweats or fever
• Easy bruising or bleeding

Causes

Main causes

• CML is caused by an acquired change in the DNA of a blood stem cell. This change is not passed from parent to child and is not caused by anything you did.
• The change creates an abnormal signal that tells white blood cells to grow and divide too much.
• Doctors sometimes call the abnormal chromosome involved the 'Philadelphia chromosome'. It is a helpful label for the genetic change, not something you could have prevented.

Risk factors

• Older age is the main risk factor, as CML is much more common in adults than in children
• Being male is linked with a slightly higher risk
• Past exposure to very high doses of radiation can raise the risk, but this is uncommon
• Most people with CML have no known risk factors

When to see a doctor

See a doctor urgently if:

• A fever or feeling very unwell, especially if you are having treatment for CML
• Bleeding that is heavier than normal or does not stop
• New breathlessness, chest pain, or dizziness
• Severe pain or sudden swelling under the left ribs
• Confusion, severe headache, or sudden weakness

Book a routine appointment if:

• Ongoing tiredness that is not explained
• Losing weight without trying
• Night sweats or fevers that keep coming back
• Feeling full quickly or discomfort under the left ribs
• Easy bruising or bleeding that is new for you

Diagnosis

CML is usually found through blood tests. If your blood count is abnormal, your doctor will refer you to a blood specialist (haematologist). The specialist will confirm the diagnosis with more blood tests and usually a bone marrow test, which checks the cells inside the marrow. Genetic tests on the blood or marrow can find the specific DNA change that causes CML.

Tests that may be done

• Full blood count: counts red cells, white cells, and platelets in the blood
• Blood film: looks at the shape and number of blood cells under a microscope
• Bone marrow biopsy: a small sample of marrow is taken, usually from the hip bone, to look at the cells more closely
• Genetic tests such as PCR or FISH: look for the DNA change that causes CML
• Ultrasound scan: may be used to check the size of the spleen

What to expect at your appointment

You may need several appointments and tests before treatment starts, and waiting for results can feel stressful. Ask your specialist team to explain each step in plain words. It can help to bring someone with you, write down questions, and ask for written information or a specialist nurse contact.

Treatment

CML is treatable. The main aim is to control the disease, keep blood counts safe, and help you live as normal a life as possible. Most people are treated with targeted cancer medicines, usually tablets, that block the abnormal signal causing the extra white cells. Treatment is planned by a specialist team and checked with regular blood tests.

Self-care at home

• Take your medicines exactly as your specialist team advises, and ask before changing or stopping anything
• Keep all monitoring appointments and blood tests
• Write down side effects and tell your team, so they can help manage them
• Try to avoid people with infections when your immune system is weak, and wash your hands often
• Eat regular balanced meals and keep gently active, but rest when you need to
• Ask your team which vaccines are safe for you
• Share worries with family, friends, your specialist nurse, or a counsellor

Medical treatments

Treatment usually uses targeted medicines that block the abnormal protein made by the changed blood cells. These are often taken by mouth every day. Your team will check your blood and monitor how well the treatment is working. Some people need other types of medicine, a stem cell transplant, or a clinical trial. The plan depends on your age, health, the phase of CML, and how the disease responds. Never start, stop, or change treatment without talking to your specialist team.

When is surgery considered?

Surgery is not usually part of CML treatment. In rare cases, an operation to remove the spleen may be considered if it is very enlarged or causing problems. Your specialist team would discuss this carefully with you.

Living with this condition

For many people, CML becomes a long-term condition that is monitored and treated over years. You may have regular blood tests and clinic visits. Between visits, most people can carry on with work, family life, and hobbies, though tiredness or side effects may mean you need to pace yourself.

Lifestyle tips

• Stay physically active in a way that suits you, such as walking, swimming, or gentle exercise
• Eat a varied, balanced diet and keep to a healthy weight
• Do not smoke, and keep alcohol within safe limits
• Get enough rest and sleep
• Protect yourself from infections: wash hands, avoid people who are unwell, and ask your team about vaccines
• Tell your team about travel plans, as some treatments need extra planning

Diet and exercise

There is no special diet that treats CML. A balanced diet with plenty of vegetables, fruit, whole grains, and protein helps your body cope with treatment. Gentle regular exercise can improve energy, mood, and sleep. Ask your specialist team or a physiotherapist for advice if you are unsure what is safe for you.

Mental health and emotional wellbeing

A cancer diagnosis can bring worry, sadness, fear, and stress. Sleep and concentration may be affected, and some people feel anxious or low. These feelings are common and deserve support. Talk to your specialist team, your family doctor, or a counsellor. If you have thoughts of harming yourself, call your local emergency number or a local crisis line right away.

Prevention

CML cannot usually be prevented. It is caused by an acquired DNA change in a blood stem cell that happens for no clear reason. There is no lifestyle change known to prevent it. Focusing on general healthy habits is still good for your overall health.

Vaccines

There is no vaccine to prevent CML. People with CML or on treatment may need extra vaccines to lower infection risk, and some vaccines may not be safe during treatment. Always ask your specialist team which vaccines you need and when.

Screening programmes

There is no routine screening programme for CML. It is often found when a blood test is done for another reason. If you have ongoing symptoms that worry you, see your doctor.

Complications

If left untreated

• The number of abnormal white blood cells can keep rising and crowd out normal blood cells
• Low red blood cells can cause tiredness and breathlessness
• Low platelets can lead to bruising and bleeding
• A weakened immune system can make infections more likely
• The spleen can become very enlarged and cause pain or fullness
• In some people, CML can change into a faster-growing phase, sometimes called blast crisis, which needs urgent treatment

Long-term outlook

The outlook for CML has improved greatly over recent decades. Most people are treated with targeted medicines that control the disease for many years, and many live long, active lives. CML usually needs long-term monitoring, and treatment can change over time. Some people may be able to reduce treatment under close specialist care, but never change anything without advice. Your specialist team can give you the most accurate picture for your situation.

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