Bone marrow exam
In a bone marrow aspiration, a doctor or nurse uses a thin needle to remove a small amount of liquid bone marrow, usually from a spot in the back of your hipbone (pelvis). A bone marrow biopsy is often done at the same time. This second procedure removes a small piece of bone tissue and the enclosed marrow.
Tests and procedures used to diagnose chronic myelogenous leukemia include:
- Physical exam. Your doctor will examine you and check such vital signs as pulse and blood pressure. He or she will also feel your lymph nodes, spleen and abdomen to determine whether they are enlarged.
- Blood tests. A complete blood count may reveal abnormalities in your blood cells, such as a very high number of white blood cells. Blood chemistry tests to measure organ function may also reveal abnormalities that can help your doctor make a diagnosis.
- Bone marrow tests. Bone marrow biopsy and bone marrow aspiration are used to collect bone marrow samples for laboratory testing. These tests involve collecting bone marrow from your hipbone.
- Tests to look for the Philadelphia chromosome. Specialized tests, such as fluorescence in situ hybridization (FISH) analysis and the polymerase chain reaction (PCR) test, analyze blood or bone marrow samples for the presence of the Philadelphia chromosome or the BCR-ABL gene.
Phases of chronic myelogenous leukemia
The phase of chronic myelogenous leukemia refers to the aggressiveness of the disease. Your doctor determines the phase by measuring the proportion of diseased cells to healthy cells in your blood or bone marrow. A higher proportion of diseased cells means chronic myelogenous leukemia is at a more advanced stage.
Phases of chronic myelogenous leukemia include:
- Chronic. The chronic phase is the earliest phase and generally has the best response to treatment.
- Accelerated. The accelerated phase is a transitional phase when the disease becomes more aggressive.
- Blast. Blast phase is a severe, aggressive phase that becomes life-threatening.
The goal of chronic myelogenous leukemia treatment is to eliminate the blood cells that contain the abnormal BCR-ABL gene that causes the overabundance of diseased blood cells. For most people, treatment begins with targeted drugs that may help achieve a long-term remission of the disease.
Targeted drug therapy
Targeted drugs are designed to attack cancer by focusing on a specific aspect of cancer cells that allows them to grow and multiply. In chronic myelogenous leukemia, the target of these drugs is the protein produced by the BCR-ABL gene — tyrosine kinase.
Targeted drugs that block the action of tyrosine kinase include:
- Imatinib (Gleevec)
- Dasatinib (Sprycel)
- Nilotinib (Tasigna)
- Bosutinib (Bosulif)
- Ponatinib (Iclusig)
Targeted drugs are the initial treatment for people diagnosed with chronic myelogenous leukemia. Side effects of these targeted drugs include swelling or puffiness of the skin, nausea, muscle cramps, fatigue, diarrhea and skin rashes.
Blood tests to detect the presence of the BCR-ABL gene are used to monitor the effectiveness of targeted drug therapy. If the disease doesn't respond or becomes resistant to targeted therapy, doctors may consider other targeted drugs, such as omacetaxine (Synribo), or other treatments.
Doctors haven't determined a safe point at which people with chronic myelogenous leukemia can stop taking targeted drugs. For this reason, most people continue to take targeted drugs even when blood tests show remission of the disease. In certain situations, you and your doctor might consider stopping treatment with targeted drugs after considering the benefits and risks.
Bone marrow transplant
A bone marrow transplant, also called a stem cell transplant, offers the only chance for a definitive cure for chronic myelogenous leukemia. However, it's usually reserved for people who haven't been helped by other treatments because bone marrow transplants have risks and carry a high rate of serious complications.
During a bone marrow transplant, high doses of chemotherapy drugs are used to kill the blood-forming cells in your bone marrow. Then blood stem cells from a donor are infused into your bloodstream. The new cells form new, healthy blood cells to replace the diseased cells.
Chemotherapy is a drug treatment that kills fast-growing cells in the body, including leukemia cells. Chemotherapy drugs are sometimes combined with targeted drug therapy to treat aggressive chronic myelogenous leukemia. Side effects of chemotherapy drugs depend on what drugs you take.
Clinical trials study the latest treatment for diseases or new ways of using existing treatments. Enrolling in a clinical trial for chronic myelogenous leukemia may give you the chance to try the latest treatment, but it can't guarantee a cure. Talk to your doctor about what clinical trials are available to you. Together you can discuss the benefits and risks of a clinical trial.
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.
Lifestyle and home remedies
For many people, chronic myelogenous leukemia is a disease they will live with for years. Many will continue treatment with imatinib indefinitely. Some days, you may feel sick even if you don't look sick. And some days, you may just be sick of having cancer. Self-care measures to help you adjust and cope with a chronic illness include:
- Talk to your doctor about your side effects. Powerful cancer medications can cause many side effects, but those side effects often can be managed with other medications or treatments. You don't necessarily have to tough them out.
- Don't stop treatment on your own. If you develop unpleasant side effects, such as skin rashes or fatigue, don't simply quit your medication without consulting your health care professionals. Likewise, don't stop taking your medications if you feel better and think your disease may be gone. If you stop taking medication, your disease can quickly and unexpectedly return, even if you've been in remission.
- Ask for help if you're having trouble coping. Having a chronic condition can be emotionally overwhelming. Tell your doctor about your feelings. Ask for a referral to a counselor or other specialist with whom you can talk.
No alternative medicines have been found to treat chronic myelogenous leukemia. But alternative medicine may help you cope with fatigue, which is commonly experienced by people with chronic myelogenous leukemia.
You might experience fatigue as a symptom of your disease, a side effect of treatment or as part of the stress that comes with living with a chronic condition. Your doctor can treat fatigue by controlling the underlying causes, but often medications alone aren't enough.
You may find relief through alternative therapies, such as:
- Journal writing
- Relaxation techniques
Talk to your doctor about your options. Together you can devise a plan to help you cope with fatigue.
Coping and support
Chronic myelogenous leukemia often is a chronic disease and requires long-term treatments. To help you cope with your cancer journey, try to:
Learn enough about chronic myelogenous leukemia to make decisions about your care. The term "leukemia" can be confusing, because it refers to a group of cancers that affect the bone marrow and blood. Don't waste time gathering information that doesn't apply to your kind of leukemia.
Ask your health care professionals to write down information about your specific disease. Then narrow your search and seek out only trusted, reputable sources, such as the Leukemia & Lymphoma Society.
- Turn to family and friends for support. Stay connected to family and friends for support. It can be tough to talk about your diagnosis, and you'll likely get a range of reactions when you share the news. But talking about your diagnosis and passing along information about your cancer can help. So can the offers of practical help that often result.
- Connect with other cancer survivors. Consider joining a support group, either in your community or on the internet. A support group of people with the same diagnosis can be a source of useful information, practical tips and encouragement.
Preparing for your appointment
Start by making an appointment with your family doctor if you have any signs or symptoms that worry you. If blood tests or other tests and procedures suggest leukemia, your doctor may refer you to a specialist in the treatment of blood and bone marrow diseases and conditions (hematologist).
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready, and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements that you're taking.
- Consider taking a family member or friend along. Sometimes it can be difficult to take in all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions will help make the most of your time together. List questions from most important to least important in case time runs out. For chronic myelogenous leukemia, some basic questions to ask your doctor include:
- Can you explain what my test results mean?
- Do you recommend any other tests or procedures?
- What is the phase of my CML?
- What are my treatment options?
- What side effects are likely with each treatment?
- How will treatment affect my daily life?
- Which treatment options do you think are best for me?
- How likely is it that I'll achieve remission with the treatments you recommend?
- How quickly must I make a decision on my treatment?
- Should I get a second opinion from a CML specialist? What will that cost, and will my insurance cover it?
- Are there brochures or other printed material that I can take with me? What websites do you recommend?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions that occur to you.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow time later to cover other points you want to address. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?