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What is the treatment for CML?

Q: I am 33 years old housewife, I have CML and I am taking Hydrea since last 7 months. Every month I go for checking. This month my TLC, platelets, and Hb were normal. The doctor told me to take 1 tablet/day (500 mg) hydrea. 1. My question is I am very hungry and I am becoming fat. 2. Are the tests required every month (TLC, Hb, Platelets)? 3. How many years can I live?

A:CML involves the overproduction of white blood cells, which accumulate in both the blood and the bone marrow. With CML, the spleen often becomes enlarged as a result of the flooding of the blood system with these cells. CML is divided into three distinct or separate phases: chronic, accelerated and blast transformation. In the chronic phase (5-6 years), a CML patient lives relatively free of symptoms. The leukaemia is often controlled by mild chemotherapy taken orally. Hospital visits are infrequent (every 6-8 weeks). After a period of time, often a number of years, CML will move into the accelerated phase, becoming resistant to mild chemotherapy used in the initial phase of the disease. An increased white blood cell count and a gradual return of symptoms mark acceleration of CML. Normal activity is affected. More frequent hospital visits are required. The accelerated phase lasts for a relatively short time period (6-9 months). In the blast phase, the disease converts to its acute form, becoming almost totally resistant to chemotherapy. Immature leukaemia cells rapidly accumulate in the marrow. These immature cells or blasts are released into the bloodstream, causing the white count to increase rapidly. The spleen may again increase in size. During this phase, closer hospital supervision is required. Often patients may require blood transfusions or antibiotics to help fight infections. In the blast phase, survival is very short even with very aggressive chemotherapy (3-6 months). The treatment options include: 1. Bone marrow transplant (BMT) from a related, unrelated or self donor. 2. Injections of alpha-interferon. This medicine can be used with some patients in early phase CML. 3. Oral chemotherapy (e.g. hydroxyurea or busulfan) is used to control blood counts and symptoms in the early or chronic phase of the disease. 4. Newer drugs like Imatinib can help. Regular blood counts need to be done to regulate the dose of hydrea.


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