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Saturday, Oct 21st

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Home Cancer Leukemia Chronic Myeloid Leukemia - Bone Marrow Transplantation

Chronic Myeloid Leukemia - Bone Marrow Transplantation

Patients who have a suitable matched bone marrow donor and who are young enough, that is under 55 years of age, are likely to be offered a Bone Marrow Transplant during the chronic phase.

If no donor is available, or the patient is too old for a donor transplant, the patient’s own marrow may be taken during chronic phase and stored to be returned during accelerated phase. This autologous transplant will not cure the disease but it may return the condition to the chronic phase, and so extend survival.

Bone marrow transplant should be done as early as possible. It is very important to realize that transplants done. The length of chronic phase is not always predictable and it is therefore extremely risky to delay transplant if a donor is available. Transplants done within the first year after diagnosis are very much more successful than those delayed until accelerated phase has begun.

Supportive Care
Blood Transfusion
A patient with chronic myeloid leukemia may become anemic in the accelerated or blast phase as the leukemia cells replace the normal bone marrow. For this reason, they may need blood transfusions perhaps as often as two or three times per week. They may also need transfusions of platelets if the count is particularly low.

Infection Prevention
Patients may be given antibiotics by mouth to help prevent bacterial and fungal infections. These drugs usually cause few or no side–effects. It is best that these drugs are taken regularly, but occasionally missing one or two doses will do no harm.

Other precautions against infection for patients with very low white counts include protective isolation and a clean food diet. Protective isolation means being nursed in a single room. All visitors should be free of infections such as coughs and colds. Visitors will be asked to wash their hands in antiseptic solution and before entering the room.

Patients rarely need any of these precautions until the accelerated or blast phases of the disease.

Prognosis
The most important points in considering the outlook (prognosis) for a chronic myeloid leukemia patient are the phase of their illness and the length of time since diagnosis. Most patients are in chronic phase when they are first diagnosed. Death rarely occurs in the chronic phase. 85% of patients die while in the blast phase. The overall median survival of patients in the chronic phase is 4–5 years.

Once a patient has entered accelerated phase the median survival is less than a year unless a bone marrow transplant can be given. Once blast phase commences the median survival is a matter of a few months. Patients with lymphoid blast crisis may survive a little longer with appropriate treatment. The most common cause of death is an overwhelming infection.

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