Chronic granulocytic leukemia (CGL) or CML is a rare cancer affecting the blood cells. "Chronic" in the chronic granulocytic leukemia (CGL) is a term that indicates a type of cancer that slowly progresses as compared to acute types of cancer.

Children are less affected as compared to adults. Nevertheless it is worth noting the fact that this type of cancer can occur at any age.

Chronic Granulocytic Leukemia

Causes of Chronic Granulocytic Leukemia (CGL) or CML

Older males are more affected by chronic granulocytic leukemia (CGL) or CML. This is when two chromosomes have swapped sections with one another. This chromosome was discovered in Philadelphia and hence the name attributed to it. Philadelphia chromosome is formed when chromosome 9 and 22 exchanges genetic materials. It is worth noting the fact that human have 23 chromosomes.

Uncontrolled growth of white blood cell will result due to the resulting gene which makes a protein known as tyrosine kinase. The resulting white blood cells do not die easily and or become old with time. The bone marrow will be damaged with the vast accumulation of white blood cells. This is the place where platelets, red blood cells and white blood cells are manufactured. This process hinders the bone marrow form manufacturing the normal amount of blood cells leading to chronic granulocytic leukemia (CGL) or CML.

Signs and Symptoms of Chronic Granulocytic Leukemia (CGL) or CML

The signs and symptoms of chronic granulocytic leukemia (CGL) or CML are:

  • Patient will bleed easily
  • Being tired or run-down
  • Fever
  • Losing weight unintentionally
  • Losing the urge to eat
  • Below the left rib will be a fullness that is painful
  • The skin becomes pale
  • Night sweating or severe sweating during sleep.

Risk Factors for Chronic Granulocytic Leukemia (CGL) or CML

The risk factors of chronic granulocytic leukemia (CGL) or CML includes the following:

  • Aging
  • Sex (male)
  • Exposure to radiation for example radiation treatment for other types of cancer.

Risk factor does not include family history. Offspring's do not inherit the chromosomal mutation that leads to chronic granulocytic leukemia (CGL) or CML. This type of mutation is developed after being born and thus it is termed as being acquired.

Complications in Chronic Granulocytic Leukemia (CGL) or CML

The complications that can be caused by chronic granulocytic leukemia (CGL) or CML include:

  • Tiredness: Anemia may occur as a result of the red blood cells being overcrowded by the uncontrolled growth of the white blood cells.
  • Joint and Bone Pain: Due to the expansion of the bone marrow, there might be pain that may occur and this causes pain in the joints and the bone.
  • Heavy bleeding: Clotting of blood is often due to the presence of platelets in our blood system. This results in the control of bleeding. Thus if there is a lack of plates in your blood system (thrombocytopenia) will make you more vulnerable to bleed and get bruised. Nose bleeding may occur frequently and will always be severe. Your skin will be dotted red because of internal bleeding (petechiae) and even the gums will be bleeding.
  • Swollen Spleen:The spleen will be storing the excess white blood cells that are produced due to chronic granulocytic leukemia (CGL) or CML. You may experience pain at the lower side of you left-rib due to the fact that the swollen spleen makes you fell full every time after a small meal.
    Infections are always being fought out by white blood cells in our bodies. Despite the fact this cells are enormous in amount when an individual have chronic granulocytic leukemia (CGL) or CML, the fact is still the same that the cells cannot do their job properly because they are diseased. Thus infection cannot be fought as compared to when normal white blood cells are present. Drop of the count of white blood cells can result when you are receiving treatment (neutropenia) which raises your vulnerability to infection.
  • Chronic granulocytic leukemia (CGL) or CML is a fatal condition if appropriate diagnosis cannot be attained.

Tests to Diagnose Chronic Granulocytic Leukemia (CGL) or CML

Chronic granulocytic leukemia (CGL) or CML diagnostic procedures include:

  • Physical exam. Blood pressure and pulse are some of the vital areas that your doctor must physically examine for signs of chronic granulocytic leukemia (CGL) or CML.
  • Blood test. Blood cells abnormality can be revealed by complete blood count (CBC). Diagnostic procedures can be determined by your doctor through test that entails the measuring of the functionality of organs.
  • Bone marrow test. Laboratory testing is necessary and thus procedures like, bone marrow aspiration or bone marrow biopsy may be used when collecting samples of your bone marrow. Your hipbone will be the area where samples will be collected.
  • Detecting Philadelphia chromosomes through tests.

Staging in Chronic Granulocytic Leukemia (CGL) or CML

Phases are used to describe the staging of chronic granulocytic leukemia (CGL) or CML. The three phases are:

  • Chronic
  • Accelerated and,
  • Blast phase

Chronic Phase of Chronic Granulocytic Leukemia (CGL) or CML

This is still a slow development of chronic granulocytic leukemia (CGL) or CMLin a stable manner. The percentage of people who are diagnosed of the disease is 90% a total of nine out of every ten individuals. No symptoms might be evident yet when some individuals are diagnosed. Slight enlargement of the spleen and also the growing amount of platelets and white blood cells in your body is seen. Less than 1% of your blood cells in the bone marrow will be white blood cells that ere immature and are often called blasts.

Accelerated Phase of Chronic Granulocytic Leukemia (CGL) or CML

More symptoms are evident in the accelerated phase of chronic granulocytic leukemia (CGL) or CML. Unusual tiredness will usually occur. Weight loss may also result. Enlargement of your spleen is also seen. You left side of the stomach might be painful and uncomfortable under the ribs. Immature blast will amount up to 30% of all your blood count in the bone marrow.

Blast Phase of Chronic Granulocytic Leukemia (CGL) or CML

The blast phase is also known as blast crisis, blast transformation or acute phase. Chronic granulocytic leukemia (CGL) or CMLin this phase usually transforms into acute leukemia (always acute myeloid leukemia). The bone marrow is filled with many blasts in this phase. Blast will be increased in the blood also. You will be feeling unwell due to complicated symptoms. Enlargement of the spleen will result. Immature blasts will make up to 30% of you blood count. Other organs will also be having leukemia cells.

Treatment for Chronic Granulocytic Leukemia (CGL) or CML

The aim of treating chronic granulocytic leukemia (CGL) or CML is to eradicate the cells that have the abnormal gene BCR-ABL which causes the massive count of the affected blood cells. All the affected might not be possible to be eliminated in most people. Long-term remission from chronic granulocytic leukemia (CGL) or CML can be achieved through treatment of the disease.

Targeted Drugs for Chronic Granulocytic Leukemia (CGL) or CML

Aspects that promote the production of cancer cells are attacked by the designed target drugs. The protein that is being manufactured by the BCR-ABL gene called tyrosine kinase is the main target of the drugs when it is chronic granulocytic leukemia (CGL) or CML. Action of tyrokinase that is being targeted by these drugs includes:

  • Gleevec (Imatinib)
  • Spyrycel (Dasatinib)
  • Tasigna (Nilotnib)
  • Bosulif (Bosutinib)
  • Synribo (Omacetaxine)

The treatment for individuals diagnosed of chronic granulocytic leukemia (CGL) or CML is usually the use of target drugs. Other target drugs can be considered by your doctor if the disease is resistant or does not respond to treatment. Skin rashes, diarrhea, fatigue, rash, muscle cramps, nausea, skin puffiness or swellings are some of the side effects that will accrue as a result of using targeted drugs. The point of stopping the intake of targeted drugs has not yet been discerned by doctors. Even with results that have revealed remission of the chronic granulocytic leukemia (CGL) or CML people have to continue to take the drugs despite having such blood tests.

Blood Stem Cell Transplant for Treating Chronic Granulocytic Leukemia (CGL) or CML

A defective cure for the chronic granulocytic leukemia (CGL) or CML is only offered by blood stem transplant also known as bone marrow transplant. The rate of complication that is likely to accrue as a result of having a blood stem transplant is immensely high and thus this is always the viable alternative for patients who have not had prior alternative modes of treatment.

Cells that are blood forming in the bone marrow are killed by chemotherapy drugs that are administered in high doses. Your blood stream is then infused with blood stem cells that had been donated previously by a viable donor of your own blood cell.

Chemotherapy for Treating Chronic Granulocytic Leukemia (CGL) or CML

For treatments involving chronic granulocytic leukemia (CGL) or CML, other treatments are always combined with chemotherapy drugs. Oral administration of capsules is always the effective way of chemotherapy in chronic granulocytic leukemia. The type of drug that you take will determine the side effects that will result.

Biological Therapy for Treating Chronic Granulocytic Leukemia (CGL) or CML

The immune system of your body is harnessed by biological therapy in order to help with the fight against cancer. The synthetic fashion that boosts the immune system is interferon. Growth of the cells of chronic granulocytic leukemia (CGL) or CML can be hindered by interferon. If you are unable to take other viable drugs during pregnancy, this is the best option, or if other drugs have not been effective. Fatigues, flu, fever, loss of weight are some of the side effects of interferon.

Clinical Trials for Chronic Granulocytic Leukemia (CGL) or CML

New enhanced ventures which are used and the latest development on treating the disease is what entail clinical trials. Though cure is not guaranteed from clinical trials, you can be able to enroll and try new alternative and latest treatment for chronic granulocytic leukemia (CGL) or CML. The risk and the benefits involved can be debated prior to the trial.

Life Expectancy and the Overall Rate of Survival for Chronic Granulocytic Leukemia (CGL) or CML

The survival rate of cancer is usually based on analysis of an interval of five years. Five years after diagnosis of chronic granulocytic leukemia (CGL) or CML, only 59% would still be alive after five years.

Future survival rates are being enhanced by the rapid new development of drugs to combat chronic granulocytic leukemia (CGL) or CML.

Survival Rate Basing on Phase of Chronic Granulocytic Leukemia (CGL) or CML

Chronic phase is where majority of patients with chronic granulocytic leukemia (CGL) or CML lie. Blast or accelerated crisis may accrue in individuals who are not responding to treatment or have had insufficient treatment.

The amount that the body can tolerate and the treatment that have been administered will determine the prognosis during this phase.

Those in the chronic phase and are receiving TKIs (Tyrosine kinase inhibitor) will have more chance through using prognosis. Drugs like imatinib (Gleevec) raised the percentage of the survival rate to 87% according to a research study on those using the drug. Nilotinib (tasinga) proved more significantly effective than Gleevec. The standard treatment for chronic granulocytic leukemia (CGL) or CML is now both of these two drugs. As new drugs that are more effective are being developed survival rates will rise with the continuous use of these drugs.

Treatment will determine the variance of survival rate of those in the accelerated phase. If the patient's response to TKIs (Tyrosine kinase inhibitor) is positive then it might be as good as those who are still in chronic phase.

The survival rate is below 10% for those in the blast crisis. Trying to get the person back to the chronic phase through the use of drugs is the best alternative. The next option will be to try a stem cell transplant.

Prognosis for Chronic Granulocytic Leukemia (CGL) or CML

Many factors will determine chronic granulocytic leukemia (CGL) or CML prognosis. This may include:

  • The phase of chronic granulocytic leukemia (CGL) or CML.
  • Age
  • Their health condition overall.
  • The count of platelets.
  • If the spleen is enlarged.

Outlook for Chronic Granulocytic Leukemia (CGL) or CML

After chronic granulocytic leukemia (CGL) or CML diagnosis, individuals who survive will be 75% for women and 70% for men as witnessed through a research of men diagnosed with CML in 2008-2010 in England. This information is according to National Cancer Intelligence Network.

Different factors will determine the outcome of treatment of chronic granulocytic leukemia (CGL) or CML for different patients. Younger people have more outlooks when age is to be a determiner. After diagnosis of people aged 15 to 64 years of age have survival rates exceeding five years after diagnosis. 40% will survive for people older than 65 who are diagnosed.

The stage (advancement) of the chronic granulocytic leukemia (CGL) or CML is another factor that will affect the outcome of chronic granulocytic leukemia (CGL) or CML. The treatment response after diagnosis is also another factor. Your specialist will help you to determine this. This condition can be controlled through treatment for many years since it is a slow developing condition.

Effective biological therapy for treating chronic granulocytic leukemia (CGL) or CML such as dasatinib (Sprycel) nilotinib (Tasigna) and imatinib (glivec) are also effectively controlling this condition. This is known as remission which the condition that the disease is inactive and symptoms are not yet evident in the blood sample. A second remission can be administered in case of recurrence (relapse) of chronic granulocytic leukemia (CGL) or CML.

You will have stem/bone marrow transplant if biological therapies proves ineffective for your condition.

It is harder to manage chronic granulocytic leukemia (CGL) or CML in the blast stage. Chronic stage can be attained through treatment for effective management of the condition. Treatment response for chronic granulocytic leukemia (CGL) or CML is always unlikely and the likelihood of life expectancy to months rather than years.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: November 7, 2015

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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