Chronic myelogenous leukemia is a "stem"cell cancer of the blood. The disease is characterized by increasing blood counts, especially of white blood cells and platelets. The diagnosis is confirmed by finding a unique chromosome abnormality known as the Philadelphia chromosome (translocation of chromosomes 9 and 22, corresponding to the bcr-abl regions).

Typically patients are completely asymptotic at the time of diagnosis. The disease is often first suspected when blood counts are obtained for other reasons (such as an annual physical). The disease moves slowly through three phases. In the "chronic" phase the patient has no major symptoms. This phase may last 3-5 years. Next comes the accelerated phase during which the blood counts become harder to control with medications. This phase may last up to one year. Finally, the disease terminates in a "blast crisis". This phase resembles the acute leukemias and patients may experience fatigue, bleeding and infections. Unfortunately, blast crisis is difficult to treat and few patients survive.

Allogeneic bone marrow transplantation is the only known treatment that results in cures of CML. Data from the International Bone Marrow Transplant Registry on over 2000 patients suggests that over 50-60% of patients with chronic phase CML can be cured. However if the transplant is delayed the results fall, with cure rates of 20-30% in accelerated phase and 10% in blast crisis. The recent use of donor lymphocyte infusions at the time of marrow transplant relapse has further improved cure rates as many of these patients are able to be rescued. For patients without a suitable family member donor, the use of HLA-matched unrelated marrow from a volunteer donor can offer hope of cures. Recent reports have noted results similar to family donors in properly selected patients.

For patients unable to undergo allogeneic transplantation, several new treatment options are available. Interferon, either alone or with low-dose cytarabine, may reduce the amount of abnormal cancer cells. Over 50-60% of patients will experience a response and 15-20% may achieve a major response at the gene level. These responding patients may lengthen the time spent in the asymptotic chronic phase, and occasional "long-term" survival has been reported.

Autologous transplantation is entering clinical trials in this disease. Following aggressive chemotherapy, tumor free stem cells can be obtained in as many as 50% of patients. These cells can be used as part of the transplant process. Early results have suggested a potential lengthening of survival, with 50-70% survivals at 4-5 years (McGlave PB et al: Lancet 1994; 343:1486). The true role of this treatment in CML remains to be determined.

The Adult Stem Cell- Bone Marrow Transplant Program of Hackensack University Medical Center has active transplant treatment protocols for Chronic Myelogenous Leukemia. For more information on this treatment or to schedule an appointment call (201) 996-5849.

ALLOGENEIC TRANSPLANT OPTIONS

For patients with Tissue-matched (HLA-matched) brother/sister bone marrow donors allogeneic transplantation treatment protocols may be appropriate. One trial uses high-dose cyclophosphamide combined with either total body irradiation or high-dose busulfan. Following this aggressive conditioning therapy, bone marrow (or peripheral blood stem cells) from an HLA-matched donor is infused. Graft-versus-host disease prevention is accomplished with combinations of tacrolimus and methotrexate. This very aggressive curative treatment requires a one-month hospitalization.

Hackensack University Medical Center’s Adult Transplant Program is also participating in a national Eastern Cooperative Group trial comparing allogeneic transplantation, autologous transplantation, and interferon therapy in CML. This study starts at diagnosis and uses interferon as induction regimen. Patients with a donor are offered the curative transplant treatment. Patientw without a donor are assigned to either interferon therapy or an autologous transplant based on their response to initial interferon induction treatment. For more information about this treatment click here.

UNRELATED TRANSPLANT TREATMENT OPTIONS

For patients lacking a family member marrow donor, the Hackensack University Medical Center Transplant Programs are participating in several unrelated transplant protocols.

The National Marrow Donor Program has enlisted over 3 million volunteer bone marrow donors. If an HLA matched unrelated donor can be located, a transplant using high-dose cyclophosphamide and total body irradiation can be performed.

Hackensack University Medical Center is also participating in a multicenter trial evaluating the use of expanded Cord Blood Cells in the treatment of cancers and blood diseases. This trial also extends the treatment options for patients without HLA Matched relative donors. For more information click here and also review ex-vivo expansion in the stem cell laboratory section.

AUTOLOGOUS TRANSPLANT OPTIONS

As noted above, Hackensack University Medical Center’s Adult Transplant Program is participating in a national Eastern Oncology Group Trial which is exploring the value of autologous transplantation in CML among patients without a suitable HLA-matched donor. For more information click here.

NON-TRANSPLANT OPTIONS

The physicians at the Northern New Jersey Cancer Center are experienced in the diagnosis and treatment of this disease. For more information on these trials call (201) 996-5900.