Chronic Myeloid Leukaemia

Question 1

What is Chronic Myeloid Leukaemia?

Answer 1

• This is a type of cancer that affects the myeloid stem cells which have the ability to become monocytes, neutrophils, RBC and platelets
• myeloblasts not fully developed but are not completely normal - uncontrolled myeloid cell growth

Question 2

What are Blasts?

Answer 2

• Blasts are immature blood cells. They have not yet fully developed into mature, fully functioning blood cells

Question 3

What is a Blast Crisis?

Answer 3

• In CML this occurs when the disease suddenly develops more quickly
• This causes a sudden increase in blast cells in the blood and bone marrow

Question 4

What is the survival for Chronic Myeloid Leukaemia?

Answer 4

• Slowly developing condition and treatment can be under control for many years
• Doctors expect you to live a normal length of life
• Targeted treatment works very well

Question 5

What are the statistics for CML?

Answer 5

• 90% survival rate for 5 years or more after being diagnosed

Question 6

What affects the survival of CML?

Answer 6

• your age ( younger have a better prognosis)
• having a low platelet count
• how many blasts you have in your blood
• how large your spleen is

Question 7

When would you be referred for a blood test in 2 days if you are over the age of 24 years old

Answer 7

• look unusually pale
• extreme tiredness
• unexplained high temperature
• unexplained infections that won’t go away or they keep coming back
• swollen lymph glands
• bruising/ bleeding for no reason

Question 8

When would you be referred immediately to see a specialist within a few hours?

Answer 8

• unexplained red/ purple spots on the skin (petechia)
• enlarged liver/ spleen on examination

Question 9

What are the 3 phases of CML?

Answer 9

• Chronic phase
• Accelerated phase
• Blast phase

Question 10

What is the Chronic Phase of CML?

Answer 10

• Most people are diagnosed in the chronic phase
• The aim is to control your CML and get you into remission

Question 11

What is the main treatment for the Chronic Phase of CML?

Answer 11

• Tyrosine Kinase Inhibitors ( targeted cancer drug )
• Imatinib and Dasatanib

Question 12

What happens if the main treatment for the Chronic phase of CML doesn’t work?

Answer 12

• Your doctor might offer you chemotherapy and a stem cell transplant

Question 13

What is the accelerated phase?

Answer 13

• Where the abnormal blast cells take up a high proportion of the cells in the bone marrow and the blood
• In the accelerated phase the patients become more symptomatic: anaemia, thrombocytopaenia and being immunocompromised

Question 14

What is the treatment in the accelerate phase of CML?

Answer 14

• Imatinib ( Tyrosine Kinase Inhibitor)
• Or a Stem cell Transplant ( if you have progressed to accelerated phase from chronic phase, if you are fit and well)

Question 15

What is the blast cell phase?

Answer 15

• Follows the accelerated phase and involves an even high proportion of blast cells and blood
• It involves severe symptoms and pancytopenia

Question 16

What is the treatment in the blast phase of CML?

Answer 16

• A TKI on its own
• A combination of chemotherapy drugs and a TKI
• Stem cell transplant if you are well enough

Question 17

What is the chemotherapy drug hydroxycarbamide used for?

Answer 17

• This is used to lower you white blood/ platelet levels
• Supportive treatment

Question 18

What supportive treatment might you receive?

Answer 18

• Fluids - to stop tumour lysis syndrome
• Treatment to prevent/ treat infections
• Blood products for low blood cell counts

Question 19

How can you monitor your response to treatment?

Answer 19

• Haematological response
• Molecular response
• Cytogenetic response

Question 20

How do you monitor your Haematological response?

Answer 20

• This is based on whether your blood cells go back to normal levels
• This will be monitored every 2 weeks when you start treatment
• normal is when your wbc, platelets and spleen size are all normal
• and no blast cells are seen on blood film

Question 21

How do you monitor your Molecular response?

Answer 21

• This is based on how much BCR-ALB1 gene a PCR test finds
• This will be monitored every 3 months to begin with and then every 3-6 months
• A PCR test to show the number of cells that have the BCR- ABL1 gene (MR1- MR5 = MR5 is the deep molecular response with 1 or less out of every 100,000 with the gene)

Question 22

How is do you measure your Cytogenetic Response ?

Answer 22

• Based on the number of bone marrow cells with the Philadelphia chromosome

Question 23

What are the reasons you may have a stem cell transplant for CML?

Answer 23

• your CML is no longer responding to targeted cancer drugs
• your CML has moved from the chronic to the accelerated phase
• you have blast phase CML

Question 24

What is a treatment break?

Answer 24

• When you take a break from medication to treat your CML

Question 25

Who is advised to have a treatment break?

Answer 25

• People on TKIs for around 5 years
• People in remission for a long time
• you are keen for a break

Question 26

How is CML monitored on a treatment break?

Answer 26

• monthly for 6 months
• every 6 weeks to 2 months for 6 months
• every 2/3 months after

Question 27

When do you need to go to hospital?

Answer 27

Symptoms:
- change in temp
- aching muscles
- headaches
- feeling cold/ shivery and unwell

Question 28

How do you prevent infections?

Answer 28

• a yearly flu vaccine
• a covid vaccine