Chronic Myeloid Leukaemia Flashcards
What is Chronic Myeloid Leukaemia?
- 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
What are Blasts?
- Blasts are immature blood cells. They have not yet fully developed into mature, fully functioning blood cells
What is a Blast Crisis?
- 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
What is the survival for Chronic Myeloid Leukaemia?
- 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
What are the statistics for CML?
- 90% survival rate for 5 years or more after being diagnosed
What affects the survival of CML?
- 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
When would you be referred for a blood test in 2 days if you are over the age of 24 years old
- 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
When would you be referred immediately to see a specialist within a few hours?
- unexplained red/ purple spots on the skin (petechia)
- enlarged liver/ spleen on examination
What are the 3 phases of CML?
- Chronic phase
- Accelerated phase
- Blast phase
What is the Chronic Phase of CML?
- Most people are diagnosed in the chronic phase
- The aim is to control your CML and get you into remission
What is the main treatment for the Chronic Phase of CML?
- Tyrosine Kinase Inhibitors ( targeted cancer drug )
- Imatinib and Dasatanib
What happens if the main treatment for the Chronic phase of CML doesn’t work?
- Your doctor might offer you chemotherapy and a stem cell transplant
What is the accelerated phase?
- 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
What is the treatment in the accelerate phase of CML?
- 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)
What is the blast cell phase?
- Follows the accelerated phase and involves an even high proportion of blast cells and blood
- It involves severe symptoms and pancytopenia
What is the treatment in the blast phase of CML?
- A TKI on its own
- A combination of chemotherapy drugs and a TKI
- Stem cell transplant if you are well enough
What is the chemotherapy drug hydroxycarbamide used for?
- This is used to lower you white blood/ platelet levels
- Supportive treatment
What supportive treatment might you receive?
- Fluids - to stop tumour lysis syndrome
- Treatment to prevent/ treat infections
- Blood products for low blood cell counts
How can you monitor your response to treatment?
- Haematological response
- Molecular response
- Cytogenetic response
How do you monitor your Haematological response?
- 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
How do you monitor your Molecular response?
- 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)
How is do you measure your Cytogenetic Response ?
- Based on the number of bone marrow cells with the Philadelphia chromosome
What are the reasons you may have a stem cell transplant for CML?
- 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
What is a treatment break?
- When you take a break from medication to treat your CML
Who is advised to have a treatment break?
- People on TKIs for around 5 years
- People in remission for a long time
- you are keen for a break
How is CML monitored on a treatment break?
- monthly for 6 months
- every 6 weeks to 2 months for 6 months
- every 2/3 months after
When do you need to go to hospital?
Symptoms:
- change in temp
- aching muscles
- headaches
- feeling cold/ shivery and unwell
How do you prevent infections?
- a yearly flu vaccine
- a covid vaccine
