Chronic Phase
Nearly all CML patients are diagnosed when they are still in the chronic phase of the disease, which can usually be controlled by chemotherapy. The goal of treatment is not to bring about remission, but instead to control the disease. The drug alpha-interferon is most commonly used. Other drugs that may be used include hydroxyurea, cytarabine and busulfan.
In the chronic phase of CML, blood counts return to normal within several months and can be maintained at near normal levels. The spleen decreases toward its usual size. Infections and abnormal bleeding are infrequent.
Patients may return to their normal daily activities once the initial treatment has been completed. However, they still need to receive frequent treatments and periodic checks of their health status and blood counts. Less frequently, they may need to have marrow evaluations.
Side Effects
The use of interferon is associated with flu-like side effects-fever, muscle aches and weakness. If patients experience prolonged fatigue or weight loss, their dose may need to be reduced. Hair loss, diarrhea, depression, ulcers on the lining of the mouth, cardiac effects and other side effects may require changes in treatment.
Acute Transformation of the Chronic Phase
The second phase of CML is called the "accelerated phase," in which the number of white blood cells and immature "blast cells" in the bloodstream increase. This phase resembles acute leukemia and is also referred to as the "blast phase." It is usually resistant to chemotherapy, so more aggressive treatments, such as those used in acute leukemias, must be utilized.
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