Chronic myeloid leukemia (CML), a slow-growing blood cancer, affects people of all backgrounds, but understanding its nuances within the Black community is crucial. While less common than some other cancers, CML presents unique challenges for Black patients, including potential disparities in diagnosis, treatment access, and outcomes. This article aims to shed light on CML, addressing its symptoms, diagnosis, treatment options, and importantly, the specific considerations for Black individuals.
In this Q&A, Black doctor Dr. Ruemu Birhiray, a hematologist/oncologist and clinical investigator at Hematology Oncology of Indiana in Indianapolis, explains chronic myeloid leukemia (CML), its treatment options, and what patients should know about this blood cancer.
BDO: What exactly is chronic myeloid leukemia?
Dr. Reumu Birhiray: Chronic myeloid leukemia (CML) is a type of blood cancer that belongs to the group of myeloid disorders. It affects the bone marrow, specifically the myeloid cells, which are responsible for fighting infections. CML is characterized by the presence of a unique gene mutation called the Philadelphia chromosome. Unlike acute myeloid leukemia, CML involves more mature cells of myeloid origin. If left untreated, most people would die from CML within 3 years of diagnosis.
Q: Are there any known causes or risk factors for CML?
Dr. Birhiray: There are no definitive causes known for CML. Some studies suggest potential links to exposure to pesticides, herbicides, or chemicals like benzene, but these connections are not firmly established. For most patients, there is no known risk factor.
Q: Are Black Americans at higher risk for CML?
Dr. Birhiray: No, Black Americans do not have a higher risk for CML compared to other racial groups. The disease can affect people of all backgrounds.
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Q: What are the treatment options for CML?
Dr. Birhiray: Treatment for CML has significantly improved since 1998. The primary treatment involves targeted medications called tyrosine kinase inhibitors (TKIs), which address the Philadelphia chromosome mutation. The first of these drugs was Gleevec (imatinib), but now there are several options available. Most patients take these medications in pill form, and some may even stop treatment after achieving long-term remission.
Q: What are the early symptoms of CML?
Dr. Birhiray: Early symptoms can include fatigue, enlarged spleen, and abnormal blood test results showing increased white blood cell count and anemia (low red blood cell count). Sometimes, CML is discovered through routine blood tests before symptoms appear.
Q: What should someone do if they’re diagnosed with CML?
Dr. Birhiray: The first step is to consult with a specialist in blood cancers who is experienced in treating CML. The specialist will conduct tests to confirm the diagnosis and measure the levels of the Philadelphia chromosome in the blood. This information helps guide treatment decisions and monitor the patient’s response to therapy.
Q: Does having CML weaken your immune system?
Dr. Birhiray: While CML may cause some degree of immune suppression, patients are not considered highly immunocompromised. There might be a slightly increased risk of certain infections, but it’s not as significant as with some other conditions.
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Q: Is CML hereditary?
Dr. Birhiray: Generally, CML is not considered an inherited disease. While there have been rare cases of families with inherited gene mutations related to CML, the vast majority of CML cases are not passed down through families.
Dr. Birhiray emphasized the importance of including people of color in clinical studies to ensure that research data is applicable to all populations.
Q: How is CML diagnosed?
Dr. Birhiray: CML is typically diagnosed through blood tests and bone marrow examinations. A complete blood count (CBC) may show an elevated white blood cell count, and a bone marrow biopsy can confirm the presence of abnormal cells. The definitive diagnostic test is genetic analysis to identify the Philadelphia chromosome, which is present in nearly all CML cases.
Q: What is the long-term outlook for CML patients?
Dr. Birhiray: Thanks to advances in treatment, particularly the development of TKIs, the prognosis for CML patients has improved dramatically. Many patients can achieve long-term remission and have a normal life expectancy. However, it’s crucial for patients to adhere to their treatment plan and attend regular follow-up appointments to monitor their condition and adjust therapy as needed.
