Find out about chronic myeloid leukaemia (CML), where it starts and how it may affect your blood cells.
What leukaemia is
Leukaemia is a blood cancer. Blood cells are made in your bone marrow. The bone marrow is the soft inner part of some of your bones.
In most types of leukaemia, abnormal white blood cells are made in the bone marrow. These cells can get into the bloodstream and circulate round the body. They do not develop properly and so do not work normally. They don't give you the protection from infection that they should. Because there are too many of these abnormal white blood cells, they stop the bone marrow producing enough healthy blood cells.
They can also build up in the lymph nodes and spleen and cause swelling.
There are different types of leukaemia. They are divided into two main groups:
- acute leukaemia
- chronic leukaemia
Acute and chronic leukaemia
Leukaemia is acute or chronic depending on how quickly it progresses.
Chronic leukaemia tends to develop very slowly. You may have a chronic leukaemia for months or years without having many symptoms. It may be stable for months or years before it gets worse.
There are 3 main types of chronic leukaemia:
- chronic lymphocytic leukaemia (CLL)
- chronic myeloid leukaemia (CML)
- hairy cell leukaemia
The word acute means that the leukaemia can develop fairly quickly. There are 2 main types of acute leukaemia:
- acute myeloid leukaemia (AML)
- acute lymphoblastic leukaemia (ALL)
Blood cells and leukaemia
To understand why leukaemia affects you the way it does, it helps to know how blood cells are normally produced and what they do.
Normally, blood cells are produced in the bone marrow. The body makes them in a controlled way. All blood cells start as the same type of cell, called a stem cell. This earliest stem cell then develops into:
- red blood cells (erythrocytes)
- white blood cells (granulocytes, monocytes or lymphocytes)
The type of chronic leukaemia you have depends on what type of white blood cell has become cancerous. In CML, it’s the granulocyte white blood cells that are cancerous. You may also hear CML referred to as chronic granulocytic leukaemia (CGL).
What blasts are
Immature blood cells are called blasts. In CML, the disease can enter a phase where it suddenly begins to develop more quickly. There is a sudden increase in blast cells in the bone marrow and blood. This is called blast crisis.
How leukaemia affects the blood cells
White blood cells help to fight infection. If you have abnormal white blood cells they cannot fight infection so well. You may get a lot of infections, which may be difficult to get rid of.
When too many white blood cells are made, they take up much more room in the bone marrow than they would normally. This means that there is not enough space for making normal red blood cells and platelets. Red blood cells carry oxygen round the body. If you don't have enough of these, you have anaemia. This can make you tired and breathless.
Platelets are vital for normal blood clotting. If you do not have enough platelets, you will have bleeding problems such as nosebleeds, easy bruising, very heavy periods or a fine rash of red spots caused by bleeding into the skin (petechiae).
Most body cells contain chromosomes. Chromosomes are made up of thousands of genes. There are 23 pairs of chromosomes in human cells and each chromosome has a number from 1 to 23. These are a bit like an instruction manual for building the body and keeping it healthy.
Most people with CML have an abnormal chromosome called the Philadelphia chromosome. This happens when a gene called the ABL1 gene on chromosome 9 breaks off and sticks to a gene called the BCR gene on chromosome 22.
This produces a new gene called BCR-ABL1, known as a fusion gene. The changed chromosome 22, which looks shorter than normal, is called the Philadelphia chromosome.
This process is called chromosomal translocation. It is a known type of genetic abnormality that can happen when a cell divides to form new cells. It is not something that is inherited. So you were not born with it and it can't be passed on to your children.
The Philadelphia chromosome makes the cell produce a protein, called tyrosine kinase, that encourages leukaemia cells to grow and multiply.
Doctors can pick up the Philadelphia chromosome on blood and bone marrow tests, and use it to help diagnose CML and to monitor response to treatment.
Watch this 2 minute video to explain what Philadelphia positive leukaemia is.
The human body is made up of trillions of cells. Inside each cell is a nucleus and within the nucleus are the cell’s chromosomes. There are 23 pairs in total.
Chromosomes are made up of DNA, which gives the instructions that tell a cell what to do. Sections of DNA are called genes. They carry the information that makes you you. For example, they tell your body what colour your hair will be or what colour your eyes will be.
Genes also tell your cells when to divide and grow, and when to die.
When cells divide to make new cells, they make exact copies of the chromosomes.
In Philadelphia chromosome positive leukaemia an abnormal change happens to chromosomes 9 and 22. Part of chromosome 9 breaks off where the gene ABL1 is located and part of chromosome 22 breaks off where the BCR gene is located. The broken parts swap places creating a new gene on chromosome 22.
This new chromosome is called the Philadelphia chromosome and the new gene is called BCR-ABL1. This new gene tells the cell to make a large quantity of a protein called tyrosine kinase which encourages leukaemia cells to grow.
There are targeted cancer drugs that can block the protein and stop the leukaemia from growing. These drugs are called tyrosine kinase blockers. You take them as tablets.
For more information about your type of leukaemia and treatments go to CRUK.org/about-cancer/leukaemia.
How common is chronic myeloid leukaemia?
Around 790 people are diagnosed with CML in the UK each year. Although it can be diagnosed at any age, it's more common in older people.