CML (Chronic Myeloid Leukaemia)

Today I am going to write about by illness. First let me give you a quick update. Day +4; two weeks in hospital about 4 more weeks to go. My energy levels are good and I am doing well. I had a reasonably good nights sleep. The problem is that they wake you up every two hours to check your temperature and pressure. They had to give me some blood last night as my Hemoglobin levels were low. Hemoglobin (HB) is the iron-containing oxygen-transport metalloprotein in the red blood cells.

They closely track 4 counts, the wcc (white cell count) which helps to fight infection, neut (neutrophils) which is a type of white cell and is the main agent in helping to prevent infection, hemoglobin and plts (plateletes) that help the blood to clot and prevent bleeding.

Leukaemia is a blood cancer. There are many types of Leukaemia and my type is classified as CML (Chronic Myeloid Leukaemia). The early symptoms for me were weight loss, exhaustion and night sweats. My wcc had risen to over 100 (typical range is (3.5-10). Usually the presence of the Philadelphia chromosome confirms that a patient is suffering from CML.

Cancer is the presence of abnormal cells. In the case of CML, two chromosomes, 9 & 22 translocate to form a fusion gene BCR-ABL. There are three phases of the disease, the chronic phase which the disease usually presents itself and may last for over 2 years before going into the accelerated phase and then the final phase is the blast crisis phase. They key is to prevent the blast crisis phase.

The recent new breed of tyrosine kinase inhibitor drugs (such as Dasatanib, Nilotanib etc…) has helped to very successfully treat patients with CML and get them into a state of remission in the chronic phase. In layman’s terms this drug breaks down the BCR-ABL so that it is able to kill them off.

In the acceleration phase, the fusion happens at a faster rate than at which the drugs can work. It seems like that there is consensus on the best cure at this stage is a bone marrow/stem cell transplant.

There may be some confusion about the difference between a bone marrow transplant and a stem cell transplant. In essence it provides the same result. New stem cells to the patient. With the advances in medical technology, they are now able to extract the stem cells from the donors blood instead of extracting it from the the marrow in the donors bone. They now do more stem cell transplants than bone marrow transplants.

Like with anything there is a grey area between the phase of the disease. It may not be crystal clear if one is in the chronic phase or the accelerated phase. When I was first diagnosed, my Consultant at St. Vincent’s Hospital felt that I was in the chronic phase of the disease and when I was transferred to St. James Hospital to be put on a new drug trial, my Consultant here had no doubt that I was in the accelerated phase of the disease. I will talk about this in another posting of how I went about wrestling this in my mind and coming to accept that the best course of treatment for me was the bone marrow/stem cell transplant.