American Medical Association Family Medical Guide - American Medical Association [375]
Symptoms
People who have CML usually have symptoms at the time the disease is diagnosed. If you have symptoms of CML, you may feel ill, have little appetite, or lose weight. You may have a fever and sweat at night. In addition, if your spleen becomes enlarged from the accumulation of leukemia cells, you will have a feeling of fullness in your upper left abdomen. The excess of granulocytes in your bone marrow limits the ability of the stem cells to produce the normal amount of red blood cells (which deliver oxygen to tissues) and platelets (which enable blood to clot), which can lead to anemia (see page 610) and easy bleeding.
Diagnosis
If you are having symptoms of a blood disorder, your doctor will recommend blood tests to either rule out CML or to determine if you should have more tests. To make a definite diagnosis of CML, your doctor will probably ask you to have a bone marrow aspiration and biopsy, in which a small sample of your bone marrow is removed through a needle and syringe and examined under a microscope.
Treatment
Most people who have CML can be treated on an outpatient basis unless they are having a transplant. The first treatment consists of anticancer drugs that usually restore bone marrow production to normal and clear up the symptoms. The outlook for people with CML has improved dramatically in recent years with treatment using very high-dose chemotherapy (sometimes with radiation) followed by a stem cell transplant from a compatible donor (usually a sibling). Some people benefit from injections of interferon alfa (a genetically engineered protein that triggers an immune response). A drug called imatinib mesylate is taken by mouth. This medication, called a tyrosine kinase inhibitor, works by blocking the specific enzyme (kinase) in CML that allows the cells to become cancerous and multiply. In many cases, these treatments can induce a complete remission that may increase long-term survival.
Chronic Lymphocytic Leukemia
Chronic lymphocytic leukemia (CLL) is a cancer of lymphocytes (infection-fighting white blood cells). Instead of maturing and dying in the natural way, the cancerous blood cells multiply and stay alive longer than they should. Gradually the leukemia cells crowd out healthy white blood cells in the lymph glands and bone marrow, reducing the immune system’s ability to fight infections. The leukemia cells can overflow into the bloodstream and from there into the lymph nodes, spleen, liver, and other parts of the body. As the number of leukemia cells in the bone marrow rises, they increasingly interfere with the ability of the marrow to produce healthy new blood cells. This reduction in the number of healthy blood cells can lead to a variety of problems, including anemia (see page 610), susceptibility to infections, and bleeding.
Symptoms
CLL often produces no symptoms at first and is usually discovered by a blood test done for another reason. The first signs of this form of leukemia may be enlarged lymph glands in the neck, armpits, or groin, or a feeling of fullness in the upper left abdomen caused by an enlarged spleen (an organ of the immune system that contains lymphocytes). Sometimes the first symptoms are those caused by anemia or an infection. Some people with CLL may feel generally ill, have no appetite, lose weight, have a fever, or have night sweats. If you have any of these symptoms, see your doctor right away.
Diagnosis
If your doctor thinks you may have CLL, he or she will examine you and will recommend a blood test. If a blood test shows abnormal cells, you