Chronic myeloid leukaemia (CML)

While all types of leukaemia start in the bone marrow and affect white blood cell production, they are grouped according to which type of white blood cell is affected (lymphoid or myeloid), whether there are abnormalities in the bone marrow, and how quickly the disease develops.

Chronic leukaemia – This usually affects partly immature cells, appears gradually, and develops slowly over months to years. There are two types of chronic leukaemia: chronic lymphocytic leukaemia (CLL) and chronic myeloid leukaemia (CML).

Acute leukaemia – This affects fully immature cells, occurs suddenly, and develops quickly. See Acute Leukaemia for more information.

Each year in Australia, about 3700 people are diagnosed with a form of leukaemia, and more than 1700 of these cases are chronic leukaemia. About 340 people are diagnosed with CML annually. It is slightly more common in men than in women and is rare in children.

Chronic leukaemia is caused by changes to one or more of the genes (DNA) that control the growth and development of blood cells. These changes happen over time, but it is not known why they occur in some people and not others. The exact causes of CML are not yet understood.

Causes of CML

• Most people with CML have a genetic abnormality known as the Philadelphia chromosome or BCR-ABL gene. This abnormality cannot be passed on from parents to children, it happens during their lifetime.
• Exposure to the chemical benzene or high doses of radiation may cause CML. However, this doesn’t explain  the majority of cases.

Blood is pumped around your body to provide oxygen and nutrients to your tissues, and to remove waste products. It is made up of blood cells carried in a clear fluid called plasma. The three main types of blood cells have specific functions:

• red blood cells – carry oxygen around the body
• white blood cells – fight infection
• platelets – help the blood clot

All three types of blood cells have a limited life span and need to be continually replaced. Most are made in the bone marrow, which is the spongy part in the centre of the bones.

The bone marrow contains stem cells. These are unspecialised blood cells that first develop into immature cells known as blast cells. Normally, the blast cells then become mature red or white blood cells or platelets and carry out their set functions.

There are two families of stem cells:

• myeloid stem cells – develop into myeloblast cells and then into red blood cells, most types of white blood cells, and platelets
• lymphoid stem cells – develop into lymphoblast cells and then into lymphocytes, which are a type of white blood cell.

If myeloblast or lymphoblast cells do not mature properly or if there are too many in the blood, it can cause leukaemia.

How blood cells are made

In leukaemia, blast cells never develop into mature white blood cells. These abnormal blast cells are also called leukaemia cells.

The lymphatic system works with the white blood cells to protect the body against infection. A large network of thin tubes (lymph vessels) carries a clear fluid called lymph. The lymph travels to and from areas of lymph tissue, including the lymph nodes, spleen and liver. When leukaemia causes abnormal white blood cells to build up, the lymph tissue becomes swollen.

Lymph nodes – Also known as lymph glands, these are small bean-shaped structures that are found in the neck, underarms, chest, abdomen and groin. The lymph nodes filter out toxins and help fight infections, and also produce some blood cells.

Spleen – This is an organ on the left side of the body under the ribs. It clears out old or damaged blood cells.

Liver – This large organ removes toxins, controls sugar levels, and stores vitamins.