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Effective Practices for Chronic Myeloid Leukemia
ACCC Releases Final Report: Treating Small-Population Cancers in the Community Setting
The Association of Community Cancer Centers (ACCC) has released its study on most effective practices in the care of patients with chronic myeloid leukemia (CML). Findings suggest that successful cancer programs take a team-based approach, deploying case managers or navigators to coordinate care, which may include home and family assessment, nutrition and pharmacist consults, and easy access to the physicians, social worker, nurses, and dietitian. Because direct patient experience is more limited for small-population cancers, keeping current about new treatments is particularly important.
ACCC members can learn about most effective practices for treating patients with CML, such as those pictured above at Florida Hospital Waterman Cancer Institute, Tavares, Fla. Also featured are innovations at Sierra Nevada Memorial Hospital, Comprehensive Community Cancer Center, Grass Valley, Calif.; The Nebraska Medical Center, Omaha, Nebr.; and Sutter Medical Center in Sacramento, Calif.
Ready Reference: CML Types
Chronic Myeloid Leukemia (CML), also known as chronic myelogenous leukemia, is a type of cancer that starts in the blood-forming cells of the bone marrow and invades the blood. It is usually associated with a chromosome abnormality called the Philadelphia chromosome. In CML, leukemia cells tend to build up in the body over time, but in many cases people don't have any symptoms for at least a few years. In time, the cells can also invade other parts of the body, including the spleen. CML can also change into a fast-growing acute leukemia that invades almost any organ in the body.
Most cases of CML occur in adults, but very rarely it occurs in children, too. In general, their treatment is the same as for adults.
Leukemia is different from other types of cancer that start in organs such as the lungs, colon, or breast and then spread to the bone marrow. Cancers that start elsewhere and then spread to the bone marrow are not leukemia.
How Leukemia Starts
Any of the blood-forming or lymphoid cells from the bone marrow can turn into a leukemia cell. Once this change takes place, the leukemia cells fail to go through their normal process of maturing. Leukemia cells may reproduce too quickly, but in most cases the problem is that they don't die when they should. They survive and build up, often crowding out normal bone marrow cells. This can lead to low counts of normal blood cells. Over time, leukemia cells spill into the bloodstream and spread to other organs, where they can prevent other cells in the body from working the way they should.
Types of Leukemia
Not all leukemias are the same. Leukemias that start in early myeloid cells—the cells that become white blood cells (other than lymphocytes), red blood cells, or platelet-making cells (megakaryocytes)—are called myeloid leukemias. These are also known as myelocytic, myelogenous, or non-lymphocytic leukemias.
Leukemias that start in the cells that become lymphocytes are called lymphocytic leukemia. These are also known as lymphoblastic or lymphoid leukemias.
Leukemias are divided into four main types.
AML—Acute Leukemia Versus Chronic Leukemia
The first factor to consider in classifying a patient's leukemia is whether most of the abnormal cells are mature (look like normal white blood cells) or immature (look more like stem cells).
ALL—Acute Leukemia
In acute leukemia, the bone marrow cells cannot mature the way they should. Immature leukemia cells continue to reproduce and build up. Without treatment, most patients with acute leukemia would only live a few months. Some types of acute leukemia respond well to treatment, and many patients can be cured. Other types of acute leukemia have a less favorable outlook.
CML—Chronic Leukemia
In chronic leukemia, the cells can mature partly but not completely. These cells are not really normal, but they look more normal than the immature cells of acute leukemia. They generally do not fight infection as well as normal white blood cells do. And, of course, they survive longer, build up, and crowd out normal cells. Chronic leukemias tend to develop over a longer period of time, and most patients can live for many years. However, chronic leukemias are generally harder to cure than acute leukemias.
CLL—Myeloid Leukemia Versus Lymphocytic Leukemia
The second factor to consider in classifying leukemia is the type of bone marrow cells that are affected.
Source: American Cancer Society, Inc.
Last Medical Review: 11/05/2009
Last Revised: 11/05/2009
Reprinted with permission of the American Cancer Society, Inc. from www.cancer.org. All rights reserved.
Ready Reference: CML Fast Facts
The American Cancer Society's most recent estimates for CML in the United States are for 2009:
- About 5,050 new cases will be diagnosed with CML (2,930 in men and 2,120 in women).
- About 470 people will die of CML during 2009.
- CML accounts for about 10 to 15 percent of all leukemias.
- The average person's lifetime risk of getting CML is about 1 in 625. This disease is slightly more common in men than in women. It is also more common in whites than in African-Americans.
- The average age at diagnosis of CML is around 66 years. Over half of cases are diagnosed in people 65 and older. This type of leukemia mainly affects adults, and is only rarely seen in children.
There has been dramatic progress in treatment over the past several years, so most people with CML are now surviving at least 5 years after diagnosis.
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