Chronic myelogenous leukemia natural history: Difference between revisions
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:*High serum lactate dehydrogenase [[LDH]] in the blood is a less favorable prognostic factor | :*High serum lactate dehydrogenase [[LDH]] in the blood is a less favorable prognostic factor | ||
*Response to treatment | *Response to treatment | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]
Overview
If left untreated, majority of patients with chronic myelogenous leukemia may progress to develop fever, night sweats, and fatigue. Common complications of chronic myelogenous leukemia include bleeding andanemia. Prognosis is generally poor, and the 5-year survival rate of patients with chronic myelogenous leukemia is approximately 59.9%.[1][2]
Natural History
The symptoms of chronic myelogenous leukemia usually develop in the sixth decade of life, and start with symptoms such as fatigue, malaise, and loss of appetite. Without treatment, the patient will develop symptoms of anemia, which may eventually lead to death.[3]
Complications
Chronic myelogenous leukemia may lead to the following complications:[4]
Prognosis
In one analysis of several clinical studies, three different risk groups were identified based on a prognostic scoring system that includes several variables: age, spleen size, blast count, platelet count, eosinophil count and basophil count. In the lowest risk group, the median survival time was 98 months. In the middle group, the median was 65 months, and in the highest risk group, the median was about 42 months. Of all patients analyzed, the longest survival time was 117 months.[5] However, this study pre-dates the advent of treatments using targeted therapy. A follow-up on patients using imatinib published in the New England Journal of Medicine shows an overall survival rate of 89% after five years.[6]
The prognosis and treatment options depend on the following:
- The patient’s age
- Elderly people have a less favorable prognosis
- The phase of CML
- Accelerated or blast phase at the time of diagnosis is a less favorable prognostic factor
- The amount of blasts in the blood or bone marrow
- A high number of blasts in the blood or bone marrow at diagnosis is a less favorable prognostic factor
- The size of the spleen at diagnosis
- Splenomegaly at diagnosis is a less favorable prognostic factor
- Platelet count
- Thrombocytopenia or thrombocytosis at diagnosis is a less favorable prognostic factor
- Eosinophils and basophils
- A higher number of eosinophils and basophils in the blood samples indicates a less favorable prognosis.
- The Philadelphia chromosome
- Patients with Philadelphia chromosome (Ph+) at diagnosis have a more favorable prognosis than those who do not have the Philadelphia chromosome (Ph-)
- Presence of anemia at diagnosis is a less favorable prognostic factor
- Bone marrow involvement
- A large number of leukemia cells in the bone marrow at the time of diagnosis is a less favorable prognostic factor
- Performance status
- People with a low performance status at the time of diagnosis have a less favorable prognosis
- Serum lactate dehydrogenase blood level
- High serum lactate dehydrogenase LDH in the blood is a less favorable prognostic factor
- Response to treatment
- The treatment is effective if a person has a major cytogenetic response after treatment, which means that less than 30% of a person’s blood cells have the Philadelphia chromosome. A major cytogenetic response occurs in about 50–70% of people considered to have good-risk disease (favorable prognostic factors) and in 20% of people considered to have poor-risk disease (unfavorable prognostic factors).
- The patient’s general health.
5-Year Survival
- Between 2004 and 2010, the 5-year relative survival of patients with CML was 59.9%.[1]
- When stratified by age, the 5-year relative survival of patients with CML was 80.2% and 37.1% for patients <65 and ≥ 65 years of age respectively.[1]
References
- ↑ 1.0 1.1 1.2 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.
- ↑ National Cancer Institute. Physician Data Query Database 2015.http://www.cancer.gov/types/leukemia/hp/cml-treatment-pdq#link/_381_toc
- ↑ Canadian Cancer Society.2015.http://www.cancer.ca/en/cancer-information/cancer-type/leukemia-chronic-myelogenous-cml/finding-cancer-early/?region=ab
- ↑ Medline Plus.2015.https://www.nlm.nih.gov/medlineplus/ency/article/000570.htm
- ↑ Hasford J, Pfirrmann M, Hehlmann R, Allan NC, Baccarani M, Kluin-Nelemans JC, Alimena G, Steegmann JL, Ansari H (1998). "A new prognostic score for survival of patients with chronic myeloid leukemia treated with interferon alfa. Writing Committee for the Collaborative CML Prognostic Factors Project Group". Journal of the National Cancer Institute. 90 (11): 850–858. PMID 9625174.
- ↑ Druker BJ, Guilhot F, O'Brien SG; et al. (2006). "Five-Year Follow-up of Patients Receiving Imatinib for Chronic Myeloid Leukemia". 355 (20): 2408–2417. doi:10.1056/NEJMoa062867. PMID 17151364.