Chronic Myelogenous Leukemia

Chronic myelogenous leukemia (CML) is a chronic form of leukemia that can be managed with an oral medication. CML starts in the blood-forming cells (myeloid stem cells) found in your bone marrow (your bones’ spongy centers). The term “chronic” means that this myeloid-based cancer grows slower than some of the other blood cancers.

Your primary care provider may have found signs of CML during routine bloodwork. Maybe you haven’t been feeling 100%. Or you’ve lost weight and don’t feel like eating. Perhaps you’ve been super tired, feverish and sweaty at night. Or you’re just achy all over.

We can help find out what’s going on, confirm your diagnosis and get you on the path to treatment and recovery.

What to expect at your first visit

Finding the most effective treatment for CML depends on getting the right diagnosis. And that starts with hearing your story. At your first appointment, your provider will want to know:

• What kinds of symptoms you’re having.
• When your symptoms started.
• How your symptoms are affecting your life.
• If you’ve ever had cancer before.
• If any of your family members have or have had cancer.

During your clinic visit, you’ll also have a physical exam. Your provider will gently press around your abdomen (belly) and lymph nodes to check for swelling or lumps. They may also order more blood tests.

Tests for chronic myelogenous leukemia

Testing for CML includes several different blood tests. We’ll take blood samples and send them to our lab. There, our team of pathologists who specialize in diagnosing blood and bone marrow conditions, like CML, will look closely at these samples. We use the latest testing tools to confirm your diagnosis.

You may have tests like:

• Complete blood count (CBC): Measures and counts your blood cells to look for signs of CML.
• Bone marrow aspiration: Checks for abnormal cells in your bone marrow fluid.
• Bone marrow biopsy: Looks for abnormal cell growth in a bone marrow sample.
• FISH (fluorescence in situ hybridization) analysis: Finds and locates abnormal genes in the blood sample by marking blood cells using fluorescent dyes.
• PCR (polymerase chain reaction test): Tests the blood sample for and measures the number of specific genes in leukemia cells.

Sometimes CML can affect other parts of your body, including your spleen, kidneys and liver. It can even affect your vision. We use imaging and other blood tests to see how healthy these organs are and how well they work.

These tests also help us find out which phase the CML is in. CML in the earliest phase (chronic) tends to respond best to treatment. CML in the accelerated phase means the cancer is becoming more aggressive (growing faster). In this phase, the number of immature white blood cells (blasts) in your bone marrow and blood are elevated. This is severe and can be life-threatening.

Second Opinions for Chronic Myelongenous Leukemia

A cancer diagnosis can be a shock and leave you feeling anxious and overwhelmed. You want to feel confident about your care — and your healthcare providers. That’s why we encourage second opinions.

Our highly skilled chronic myelogenous leukemia (CML) team is here for you. We’ll take the time to listen, answer questions, explain treatment options and offer the best care centered on your needs. And because we know that cancer doesn’t wait, we work to schedule your appointment as soon as possible. A second opinion can give you peace of mind knowing that you’re in the most capable, compassionate hands.

Meet Our Chronic Myelogneous Leukemia Team

We believe in team-based care at Cleveland Clinic. This means you’ll have a dedicated care team of providers from different specialties by your side from the moment you reach out to us. They work together to confirm your diagnosis, plan highly personalized treatment and give you the support you need.

Depending on your unique needs, your team may include:

• Hematologists.
• Oncologists.
• Pathologists.
• Hematopathologists (pathologists specializing in blood disorders).
• Nurse practitioners.
• Bone marrow transplant coordinators.
• Care coordinators.
• Physician assistants.
• Social workers.

Your care team will work with you to create a personalized treatment based on your unique diagnosis and overall health. They’ll also meet regularly as you go through treatment to talk about your progress and update your care plan if needed. Treatments may include:

Targeted drug therapy

We usually start CML treatment with targeted therapy, a type of cancer medication taken as a pill. Targeted therapy drugs called tyrosine kinase inhibitors (TKIs) keep cancer cells from growing and destroy existing cancer cells without harming healthy cells.

We offer several kinds of targeted therapies that work in different ways. You may need to try more than one kind. Your providers will go over their recommendations and the options with you.Our goal with this treatment is to help you have long-term remission (no cancer cells).

Chemotherapy

Chemotherapy uses anticancer drugs to destroy leukemia cells. It may be used in combination with targeted therapy. Or we may recommend it if targeted therapy doesn’t work as well as planned. For some people, we may need to discuss having a bone marrow transplant. Although this is much less common than it was before the invention of targeted therapy.

Interferon therapy

Your body’s immune system makes interferons (proteins that help your immune system fight cancer and slow cancer cell growth). This treatment uses synthetic (human-made) interferons (interferon alpha-2b injection) that are similar to those in your body to help reduce the growth of leukemia cells. Before targeted therapy, this was the frontline leukemia treatment.

Bone marrow transplant

For some people, we may need to discuss having a bone marrow transplant (stem cell transplant). This treatment recreates your white blood cells using healthy stem cells, usually from a donor.

The process involves first getting high-dose chemotherapy and sometimes whole-body radiation therapy. Chemotherapy and radiation destroy all the cancerous cells in your body so the transplanted cells will have a better chance of growing and reproducing.

After we prepare you for the transplant, your care team adds the donor’s healthy stem cells into your bloodstream using an intravenous (IV, through your vein) infusion. These stem cells should become new white blood cells in your bone marrow, which renews your immune system.

Recovering from CML

When you have CML and need a bone marrow transplant, you may need to spend four to six weeks in the hospital. This is planned very carefully with you, your entire care team and your family.

We know it’s hard to be away from home when you aren’t feeling well, so we do what it takes to make Cleveland Clinic feel like your home away from home. On our special floor, you’ll have a large, private room with a pull-out bed for your support person, Wi-Fi and flat-screen TVs with built-in DVD players. The unit also has computers, a washer and dryer, kitchen and lounge areas and an exercise room.

We also recognize your immune system won’t be at its best during your stay. So, this special unit has the latest air-handling system to help reduce infection risks. It continuously filters the air by removing 99.98% of possible pollutants.

Long-term chronic myeloid leukemia care

Depending on how severe your CML is, you may need to have targeted therapy for a few years before your cancer goes into remission (meaning there are no signs of the cancer). Or you may need to stay on targeted therapy indefinitely. Your care team will work with you to make the best long-term treatment decisions for your needs. And they’ll do regular follow-up visits and testing to keep a close eye on your response to therapy and any side effects. We provide lifelong care, even if your treatment is a success. We want to make sure your CML doesn’t return (recur). And if it does — we’ll catch it and treat it early.

Taking the Next Step

You might feel a rollercoaster of emotions when you hear you may have chronic myeloid leukemia. But at Cleveland Clinic, you’ll have a compassionate team of skilled providers caring for you at every twist and turn. Our specialists use the latest treatments to treat your CML and can connect you with providers who can support you mentally and emotionally, too.