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Leukemia Leukemia Treatment

Making Tough Treatment Decisions About Leukemia

The diagnosis can seem like a cruel joke. One morning you wake up, feeling perfectly healthy and fit, and go to the doctor for a routine check-up. Standard blood work reveals high levels of white blood cells. More tests are performed, and suddenly you are one of over 4,000 Americans diagnosed each year with chronic myeloid leukemia, or CML. Different from acute forms of leukemia, CML allows white blood cells to mature and function normally, which accounts for the mild onset of the disease and the rude shock of diagnosis. The problem is that in people with CML, white blood cell production does not know when to quit.

Bone marrow transplantation offers the only potential cure at this point, but the procedure carries risks, and for some people transplantation is not an option. There are, however, a number of medical therapies that are providing effective treatment. Below, Dr. Gwen Nichols, director of the hematologic malignancies program at New York Presbyterian Hospital, Columbia University, talks about the disease, and the challenge of making smart decisions about treatment.

What is CML?
CML is caused by an abnormally high production of white blood cells, which are cells of the immune system made in the bone marrow. These cells have an abnormal chromosome called the Philadelphia chromosome. This chromosome causes the abnormal cells to have certain activity and growth patterns that are not regulated by the normal signals, so they grow and multiply in the blood stream. Many patients find they have CML during a routine blood test during a physical examination, and they often have no symptoms at all.

What is the normal course of the disease in CML?
It's variable, but doctors do have some road marks that can help predict the course. “We look at the characteristics of the white blood cell count when the patient is first diagnosed,” says Nichols. “We also look at whether or not they have newly-formed abnormal cells in their bone marrow.” That's associated with a worsening prognosis. The last thing that doctors look at is whether or not the CML cells have gone to other organs and are increasing the size of those organs; in particular, the spleen.

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