Causes and risk factors
CML is usually associated with presence of an abnormal chromosome called the ‘Philadelphia chromosome’. Human cell normally consists of 23 pairs of chromosomes. These contain DNA that carry information [genes] to control the cells in the body. In the blood cells of patients with CML, a section of chromosome 22 switches places with section of chromosome 9. This causes a long chromosome 9 and a short chromosome 22. This short chromosome 22 is called Philadelphia chromosome which a marker for CML. Risk factors for CML include exposure to ionizing radiation. Risk increases with age; it is common in adults than children. Males are commonly affected than females.
Clinical presentation
Clinical presentation depends upon the phase of disease. Phase indicates aggressiveness of the disease. It includes Chronic- It is the earliest phase, Accelerated- This is a transitional phase when the disease becomes more aggressive and Blastic-It is a severe, aggressive phase that becomes life-threatening. Patient of chronic myelogenous leukaemia may present with easy bleeding, bleeding from gums, bone pain, low grade fever, frequent infections, epistaxis, enlarged lymph nodes around neck, underarms, abdomen, pallor, shortness of breath, generalised weakness, fatigue, loss of appetite and weight loss, pain or fullness below the ribs on the left side, feeling full even after eating small amount of food.
Investigation
Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Physical examination may reveal spleenomegaly which suspects of the underlying disease. Tests that may be done for CML are CBC with white blood cell differential count, Bone marrow aspiration and biopsy, lumbar puncture. Testing for the presence of the Philadelphia chromosome will confirm the diagnosis. Imaging such as X ray, CT scan, PET scan and MRI will help to diagnose whether there is invasion of other organs of the body.
Treatment
Treatment depends upon depends upon the phase of disease. In early phase patient responds well to the treatment and has a good prognosis. Initial treatment includes chemotherapy which consists of 3 phases – remission induction, consolidation, and maintenance therapy; radiation therapy, targeted drug therapy, stem cell transplant and bone marrow transplant are found to be effective in treating CML. Supportive care is given to prevent any complications.
Other Modes of treatment
The other modes of treatment can also be effective in treating CML. Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating CML.
Facts and figures
CML is found in 1-2 cases per 100000 adults in world.
