White blood cells (WBC) are potent components of the blood. They are crucial for health and well-being because of their role in the fight against infection. However, an elevated white blood cell count might indicate a particular slow-growing cancer that starts in the blood-forming cells of the bone marrow called chronic myeloid leukemia.
Understanding Chronic myeloid leukemia (CML)
'In this disorder, a patient’s bone marrow produces a significantly high amount of white blood cells. These cells tend to function normally at first however, as the condition evolves, dysfunctional white blood cells called myeloblasts start to grow. Myeloblast overgrowth hinders the production of other blood cells, leaving the body short on healthy platelets and red blood cells.
CML may be indicated by a WBC count that is outside the usual range of 4,500-11,000 cells per microliter of blood. In the case of CML, the mutated gene - BCR-ABL acts as a switch that is perpetually in the ‘on’ mode, causing a high number of immature white blood cells to develop. Along with this, there is a frequent increase in blood platelets, which aid in blood clotting. Additionally, red blood cells that transport oxygen may decrease.
Currently, CML accounts for 15-20% of all adult leukemia in India. Although it can strike anyone at any age, over 70% of all cases are individuals over the age of 40. Men are diagnosed with CML more often than women, while children are infrequently diagnosed with the disease, ' said Dr. Dinesh Bhurani, Director - Department of Hematology and bone marrow transplantation, BLK-MAX, Super Speciality Hospital, New Delhi.
Phases of CML
The disease progresses in 3 phases - the chronic phase, the accelerated phase, and the blast phase.
As per Dr Dinesh in the chronic phase, myeloblasts make up fewer than 10% of blood cells, and the quantity of mature white blood cells is increased. Symptoms of CML during this phase are mild or absent and progress gradually. The chronic phase can continue for months to years.
In the accelerated phase, there are slightly more myeloblasts, which make up about 10%–29% of the blood cells. The accelerated phase typically lasts 4 to 6 months. If untreated, accelerated phase CML will eventually develop into blast phase CML
In the blast phase, myeloblasts make up at least 30% or more of blood or bone marrow cells
Patients who are diagnosed in the chronic stage can live an enhanced quality of life by adhering to long-term treatment. For severe cases, modern innovative therapy solutions are available that help the patient live a near-normal life by controlling disease progression.
Identifying CML
This condition, which results from a mutation in the body's cells rather than being inherited, cannot be passed on to future generations. A significantly enlarged spleen, persistent fatigue, bone pain, and sudden weight loss are among the signs and symptoms that might occur. In rare cases, severe infections and uncontrolled bleeding might happen that can be life-threatening.
Treatment adherence is key
Continuous monitoring of CML is crucial. It enables the doctor to recommend proper treatment and keep the issue in check. Therefore, it is advised that patients continue to take medication as prescribed by their healthcare professional.
Dr Dinesh further mentioned that, 'The majority of CML patients, tyrosine kinase inhibitors (TKIs) are the first line of treatment, and for more than two-thirds of patients, this results in long-term disease control.
For monitoring, a blood test and peripheral blood smear are undertaken to evaluate the quantification of BCR-ABL protein levels in the blood. Following the initial diagnosis of the condition, monitoring should be carried out every three to six months as recommended. Although these are the suggested periods, the frequency of monitoring is determined by an individual’s symptoms and disease progression.'
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