Chronic phase

Most often, chronic myeloid leukaemia is discovered during the chronic phase. It corresponds to the initial stage of the disease and can last up to ten years. It often proceeds without symptoms, so that the initial diagnosis is often made rather coincidentally, e.g. in the context of a routine blood test by the family doctor.

In this phase there is a gradual displacement of healthy blood-forming cells in the bone marrow. In order to be able to produce enough blood cells, the body switches to other organs for blood formation. In this context one also speaks of extramedullary blood formation.

This primarily affects the spleen, so that the organ can become very enlarged. Due to the massive increase in size, there is even a risk of a life-threatening rupture of the spleen. Occasionally, affected persons report left-sided upper abdominal complaints beforehand. There are hardly any characteristic symptoms of the chronic phase. Patients often complain about unspecific complaints such as weight loss, tiredness or night sweats.

Diagnosis

Blood sampling: Here the number of white blood cells in the blood is determined. An increased number of white blood cells is to be expected in this disease, especially in the blast phase (leukocytosis). Parameters such as the so-called ALP (alkaline leukocyte phosphatase) in the serum are also determined.

This value is lower in CML (chronic myeloid leukaemia) and differentiates this disease from other similar diseases where this value is increased. In addition, other parameters are determined which indicate an increased cell turnover in the body (uric acid, for example). The values are determined whenever blood cancer is suspected.

Bone marrow tissue collection (bone marrow biopsy) and blood smear: After analysing the tissue collection from the bone marrow with the microscope, the cells in the bone marrow can be assessed and their origin determined. In addition, a sample of blood taken from the vein can also be examined and evaluated under the microscope. Cytogenetics: The already described examination of the genetic material of the degenerated cells is crucial for both the therapy and the prognosis of the disease, because the cells of CML (chronic myeloid leukaemia) in particular have an enormously high proportion of the Philadelphia chromosome (about 95% of the cells have this atypical connection between chromosomes 9 and 22). Computer tomography (layered X-ray) and ultrasound: Enlargements of the liver as well as the spleen can be assessed by this imaging.

Therapy

Bone marrow transplantation: In this disease it is very important to find bone marrow donors, because this way this type of leukemia is curable. Chemotherapy: This type of cancer is also treated with additional chemotherapy. Leucopheresis: This method removes the very numerous cells from the blood due to the uncontrolled growth, otherwise the blood would thicken due to the increase in toughness of the blood. This would result in strokes, heart attacks or thromboses, as the blood would stop in smaller vessels and clog these vessels. Imatinib: The active substance imatinib plays a very important role in this disease in particular, as 95 % of the degenerated cells have the Philadelphia chromosome.