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Chronic Myeloid Leukemia
Reviewed by Medicinsk Expert•Last updated: 2026-10-22•Blood Heart Circulation

Chronic Myeloid Leukemia

Chronic myeloid leukemia (CML) is a slow-growing cancer of the white blood cells often linked to a specific genetic change known as the Philadelphia chromosome.

What is Leukemia?

Leukemia is a cancer of the blood cells starting in the bone marrow. The bone marrow produces white blood cells, red blood cells, and platelets. In leukemia, the bone marrow produces large numbers of abnormal cells that crowd out healthy blood cells, hindering their ability to function.

Understanding Chronic Myeloid Leukemia (CML)

Chronic myeloid leukemia (CML) is a type of chronic leukemia where the bone marrow makes abnormal granulocytes, also called blasts. These cells can crowd out healthy cells and spread to other parts of the body. CML typically occurs in adults during or after middle age and is rare in children.

Causes and Risk Factors

Most CML cases are linked to the Philadelphia chromosome, a genetic change that occurs during a person's lifetime. This change creates a new gene called BCR-ABL, which produces an abnormal protein that causes leukemia cells to grow out of control. Risk factors include:

  • Age: Risk increases with age.
  • Sex: Slightly more common in men.
  • Radiation: Exposure to high-dose radiation.

Symptoms

CML may be asymptomatic, but symptoms can include:

  • Fatigue
  • Unexplained weight loss
  • Drenching night sweats
  • Fever
  • Pain or fullness below the ribs on the left side

Diagnosis and Phases

Diagnosis involves physical exams, medical history, blood tests (CBC and chemistry), bone marrow tests (aspiration and biopsy), and genetic testing for the Philadelphia chromosome. CML progresses through three phases:

  • Chronic phase: Less than 10% blast cells; often asymptomatic.
  • Accelerated phase: 10% to 19% blast cells; symptoms are more common.
  • Blastic phase: 20% or more blast cells; the cancer has spread to other tissues.

Treatment

Treatment depends on the phase, age, and overall health:

  • Targeted therapy: Specifically tyrosine kinase inhibitors (TKIs), which block the enzyme causing blast production.
  • Chemotherapy
  • Immunotherapy
  • High-dose chemotherapy with stem cell transplant
  • Donor lymphocyte infusion (DLI): Infusing healthy lymphocytes from a donor to kill remaining cancer cells.
  • Splenectomy: Surgery to remove the spleen.

Frequently Asked Questions

The Philadelphia chromosome is a specific genetic abnormality found in most people with CML. It's formed when pieces of chromosomes 9 and 22 break off and swap places, creating a new gene called BCR-ABL. This BCR-ABL gene produces an abnormal protein that causes CML cells to grow uncontrollably. Its presence confirms a CML diagnosis and, crucially, it is the primary target for highly effective medications called tyrosine kinase inhibitors (TKIs), which have revolutionized CML treatment.
The primary treatment for CML is targeted therapy with Tyrosine Kinase Inhibitors (TKIs). These drugs, such as imatinib, nilotinib, or dasatinib, specifically block the activity of the BCR-ABL protein, preventing the growth of leukemia cells. TKIs are highly effective and have transformed CML from a rapidly fatal disease into a manageable chronic condition for most patients. In rare cases, if TKIs are not effective or tolerated, other options like chemotherapy, interferon, or stem cell transplant may be considered.
CML typically progresses through three phases. The chronic phase is the earliest and most common at diagnosis, with less than 10% blast cells in the blood or bone marrow, and often mild or no symptoms. The accelerated phase (10-19% blasts) indicates the disease is worsening, with more symptoms and a poorer response to initial treatment. The blast phase (20% or more blasts) is the most aggressive, resembling acute leukemia, with severe symptoms and requiring intensive treatment. Treatment strategies are adjusted based on the phase of the disease.
While a traditional "cure" (complete eradication of the disease without any further treatment) is rare for CML, modern TKI therapies have made it a highly manageable chronic condition for most patients. Many individuals achieve deep and durable remissions, allowing them to live long, productive lives. Some patients who achieve sustained deep molecular remission may even be able to safely discontinue TKI therapy under strict medical supervision, but for most, CML requires long-term medication to keep the disease under control.
Source: MedlinePlus, National Library of Medicine

MedlinePlus brings together authoritative health information from the National Library of Medicine (NLM), the National Institutes of Health (NIH), and other government agencies and health-related organizations.

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