Let’s Talk About Chronic Myeloid Leukemia Symptoms and Causes
好消息：这种形式的白血病是可治疗的。不那么好：你甚至可能没有意识到你有它。加快如何了解如何找出。
思想任何形式的癌症都拥有我们大多数人立即在线搜索症状和症状。但是，如果你不知道你的身体内部有恶性肿瘤会怎么样？这就是许多人诊断患有慢性骨髓白血病的情况，血液和骨髓癌的形式可能未被发现。除了疲劳（这些天没有筋疲力尽吗？），偶尔的瘀伤和一些呼吸急促，还没有太多的继续。然而，与每种形式的癌症一样，早期捕获它是关键。这是您需要知道尽快发现这种疾病。
Our Pro Panel
We went to some of the nation’s top experts on CML symptoms and causes to bring you the most up-to-date information possible.
Jun H. Choi，M.D.
Hematologist-Oncologist
NYU Langone Perlmutter Cancer Center
New York City
Gwen Nichols，M.D.
Chief Medical Officer
The Leukemia & Lymphoma Society
Rye Brook, NY
Jay Yang，M.D.
Hematologist-Oncologist
韦恩州立大学Karmanos癌症研究所
底特律，MI
简而言之，“急性”意味着快速生长，而“慢性”意味着缓慢生长。急性形式的白血病症状更严重，更难治疗。慢性形式明显更易于管理并且具有更好的预后。这是因为急性白血病的人被许多不成熟，白色血细胞的淹没，不能履行工作。那些患有慢性白血病的人仍然具有成熟的白细胞的公平份额，能够与引起的失血细胞一起运作。
The spleen is a fist-sized organ located in the upper left of your abdomen and its primary role is to to act as a filter for your blood. It performs quality control as blood passes through, destroying old and damaged red blood cells, and storing extra white blood cells and platelets until they’re needed. Over time, the leukemic white blood cells also build up, causing the spleen to become enlarged and uncomfortable, like the feeling of being too full after eating. CML treatment can reduce spleen size to normal.
很不幸的是，不行。一些癌症是生活方式选择的结果（例如吸烟导致肺癌）或环境暴露（如太阳和皮肤癌）。然而，CML从未与特定原因相关联，除了辐射曝光可能产生影响时的罕见情况。饮食，吸烟，化学品或现有感染似乎不会影响某人开发CML的风险。
不是完全的，但它可能变得更加严重。CML是独一无二的，它是白血病的唯一形式，与费城染色体和BCR-ABL1融合基因呈现。如果CML进展，它通过自己的三个阶段进行：慢性，加速和爆炸。凭借目前的TKI治疗，许多CML的人可以留在慢性，可治疗的阶段很长一段时间（因为TKIS只有在过去的20年左右只有迄今为止，我们还没有长期结果）。如果具有CML的某人进展到加速，尤其是爆炸阶段，它们的症状和血液特征也与AML相似。
What Is Chronic Myeloid Leukemia?
Chronic myeloid leukemia, or CML for short, is one of the four most common types of leukemia, a cancer of the blood and bone marrow, the soft, spongy tissue in your bones where blood cells are made. Having any form of cancer is scary, but CML perhaps less so than some others, since it’s become very treatable over the last 20 years. Once treatment begins, many people with CML say their life returned to relatively normal.
Before diving into the specifics of CML, let’s review the basics of leukemia. When you develop leukemia, your bone marrow, which normally produces new white blood cells to replace old ones that are dying off, starts to crank out excess white blood cells that are abnormal and inefficient. This may happen quickly and aggressively (classified as “acute” leukemia) or more slowly (known as “chronic”). Acute forms of leukemia produce mostly immature cells that can’t perform their job, while patients with a chronic leukemia usually have a greater number of mature cells that can carry out at least some of their functions.
In addition to acute and chronic, leukemia is also classified by the type of white blood cell affected: lymphocytes or myeloid cells. This results in the four leukemia categories: acute lymphocytic leukemia, acute myeloid leukemia, chronic lymphocytic leukemia, and chronic myeloid leukemia.
慢性骨髓白血病Causes
There is currently no easy way to tell who is going to get CML. It’s an acquired mutation in which the genetic material (DNA) in the bone marrow becomes damaged. While scientists don’t know why this happens, they do know how: In CML, a single damaged bone marrow stem cell starts to multiply rapidly. The new mutated cells continue to grow and survive and soon there are more bad cells flooding the blood system than good ones. In addition, with CML, the damaged DNA leads to the development of whole new chromosome, upsetting the apple cart further.
A quick biology lesson: All people have 23 pairs of chromosomes, inherited from their parents, that give them their unique traits. Your DNA lives in these tightly wound, thread-like chromosomes and they’re responsible for making sure the information on your traits is copied and distributed accurately each time a cell divides to produce new ones. Any changes to the number or structure of a chromosome can lead to health issues.
What Type of Mutation Causes Chronic Myeloid Leukemia?
In CML, an error called a “translocation” occurs, in which a piece of one chromosome breaks off and attaches to another chromosome forming an abnormal “fusion gene.” In this case, one piece of chromosome 9, which contains a gene known as ABL1, and one piece of chromosome 22, which contains a gene called BCR, fuse together on chromosome 22. As a result of the translocation, chromosome 9 is longer than normal and chromosome 22 is shorter than normal. This abnormal chromosome 22 is known as the Philadelphia chromosome (due to the location of its discovery). The vast majority—more than 95% of CML patients—have the Philadelphia chromosome and are referred to as “Ph positive” (Ph+). A very small number of patients be will Ph negative (Ph-), but everyone with CML has the BCR-ABL1 fusion gene.
BCR-ABL1 is what’s known as an oncogene, meaning it may cause the growth of cancer cells. Specifically, BCR-ABL1 produces a supercharged abnormal protein known as tyrosine kinase. Tyrosine kinase gives the command to crank out way too many of a certain type of white blood cells known as granulocytes that all have the BCR-ABL1 oncogene. End result: CML cells grow and divide out of control.
风险因素for Chronic Myeloid Leukemia
CML doesn’t run in families and you aren’t born with it. Risk factors are frustratingly vague, but these are a few that scientists have identified:
How Age Affects CML Risk
与许多形式的癌症一样，您的年龄较大，越大，培养慢性骨髓性白血病的机会就越大。这种疾病的平均诊断年龄是60年代中期，但它也不是较年轻的成年人的闻所未闻。
性别如何影响CML风险
虽然任何人都可以发展慢性骨髓白血病，但这种疾病似乎比女性更普遍。研究人员不确定为什么似乎是这种情况。
辐射暴露如何影响CML风险
如果您有不幸的经验，从核反应堆事故中暴露于高剂量的辐射，或者已经有放射治疗治疗另一种医学问题，则慢性骨髓白血病的风险增加。然而，应该指出的是，它仍然是一个非常小的风险。
Do I Have the Symptoms of Chronic Myeloid Leukemia?
Honestly probably not, unless you have a very advanced case. Because CML progresses slowly, many people have no idea they have it. There are enough healthy white blood cells still living alongside the rogue ones to keep symptoms at bay.
大多数人发现他们有CML，当他们去看医生的年度身体或其他需要血液工作的东西，而且计数会因可疑而回归。你的医生可能会看到什么：
增加，通常非常高，白细胞计数
a decreased red blood cell count
an increase or decrease in the number of platelets, depending on how severe the CML has become
Based on how many immature white blood cells (known as “blasts”) you have in your blood and bone marrow, your doctor will diagnose you with a CML phase. The symptoms you have (or don’t have) will likely depend on the phase you are in.
CML慢性相位症状
大多数人都诊断(再一次,在这个阶段accident) and it is the least serious. You may feel fatigued or short of breath at times, and even drop a few pounds, but likely don’t know what’s going on yet. You may also notice some discomfort or fullness on the left side of your abdomen, which indicates an enlarged spleen, a frequent issue with CML because the abnormal cells collect there. People in this phase usually respond very well to treatment with TKIs and blood counts return to normal. Left untreated, however, chronic phase CML will progress to the accelerated or blast phases.
CML加速相位症状
The number of immature blast cells is increasing rapidly. People in this phase have more than 15%, but less than 30%, blasts in the blood and bone marrow. They also have more than 20% of a type of white blood cell known as a basophil in the bloodstream (usually basophils make up less than 1% of circulating white blood cells). Symptoms during this phase include:
Shortness of breath
轻松瘀伤
由于红细胞水平低，贫血
食欲下降
Feeling very tired
有夜间汗水
具有骨疼痛，由于白血病细胞从骨髓腔扩散到骨表面
Having other chromosomal abnormalities in addition to the Philadelphia chromosome
Losing weight
Swelling, fullness, or discomfort in your abdomen or to the left of it, which is a sign of an enlarged spleen
Running a fever
CML Blast阶段症状
这是最严重的阶段，通过在血液和骨髓中具有超过30％的爆炸细胞来定义。您的症状将更加严重，除了上面列出的加速阶段，您还可以：
容易出血
发展感染
体验皮肤变化，包括颠簸和肿瘤
有肿胀的腺体
Seeing a Doctor for Chronic Myeloid Leukemia Symptoms
CML has few to no symptoms, so spotting it isn’t easy. That’s one of the many reasons to stay on top of your healthcare. A routine physical that includes a complete blood count will catch CML in its early phase when it’s very treatable. In general, healthy people in their 20s should have a physical every two to three years; those in their 30s and 40s should have one every other year; and those 50 and older should have an annual physical.
•Leukemia Statistics:Leukemia & Lymphoma Society. (2021.) “Facts and Statistics Overview.”https://www.lls.org/facts-and-statistics/facts-and-statistics-overview#Leukemia
•CML Overview:Leukemia & Lymphoma Society. (2020). “Chronic Myeloid Leukemia.”https://www.lls.org/sites/default/files/2021-05/PS31_CMLBooklet_1_21_0.pdf
•CML Guidelines:National Comprehensive Cancer Network. (2020.) “NCCN Guidelines for Patients: Chronic Myeloid Leukemia.”https://www.nccn.org/patients/guidelines/content/pdf/cml-patient.pdf.
•Phases and Prognosis:Leukemia & Lymphoma Society (2020.) “CML Phases and Prognostic Factors.”https://www.lls.org/leukemia/chronic-myeloid -leukemia/diagnosis/cml-phages-prognostic-factors.
