Tuesday, November 10, 2009
Pro athletes know their body and appreciate early when something isn’t quite right. This intuition may have led Kareem Abdul-Jabbar to seek medical help when he started to get hot flashes and sweats this fall. Many people may have ignored these symptoms and ignored them as unimportant. Hot flashes may be normal for women in menopause but not for a basketball legend who was coaching a professional team and the symptoms led to an early diagnosis of Chronic Myelogenous Leukemia.
CML is a rare type of leukemia that tends to affect older male patients. More than 90 percent of cases are due to a gene abnormality caused when two chromosome swap sections with each other. There are 23 chromosomes in humans and in patients with CML, chromosomes 9 and 22 within blood cells exchange bits of genetic material to form a Philadelphia chromosome, named after the city where it was discovered. The new gene on this chromosome makes a protein called tyrosine kinase that allows white blood cells to grow out of control. Actually, these abnormal white blood cells tend not to get old and die. The bone marrow, where red blood cells, white blood cells and platelets are made, gets filled with white cells, crowding out the normal cells and damaging the bone marrow itself.
While chills, sweating, fevers without infection and fatigue are early symptoms of CML, the later symptoms are due to decreasing function of the bone marrow. Bone and joint pain may occur as the bone marrow pressure increases due to an excess build up of white cells. Fatigue may be due to anemia because not enough red blood cells are being made. Bleeding can occur if not enough platelets are being manufactured. Interestingly, some CML patients make too many platelets and can develop abnormal blood clotting causing strokes. CML is a disease of too many white blood cells but they tend not to work properly and their ability to fight infection is compromised leading to an increased of infection. Finally, the increased numbers of white blood cells spill out of the bone marrow and start circulating in the blood stream and eventually end up being trapped in the spleen, causing it to enlarge.
The diagnosis is usually made by a CBC, (complete blood count) a common blood test that measures the number, type and characteristics of red and white blood cells and platelets. A bone marrow sample looks at the factory where the cells are being made and if the diagnosis of CML is being considered, testing for the Philadelphia chromosome may occur.
CML is a treatable disease with new drugs that target the abnormal enzyme responsible for the white cells gone bad. Gleevec, Sprycel and Tasigna all shut down the tyrosine kinase enzyme and can keep CML in remission, but once the drug is started, it will likely be taken forever. If the leukemia reactivates, the next line of treatment is a bone marrow transplant which has a long term cure rate of 60-80%.
The ability listen to your body is an important first step in finding a problem so it can be fixed. Often, CML is diagnosed when patients come in for a routine screening blood test. It’s no different than finding a problem when taking your car in for an oil change; a problem is found early and fixed. But ignored, issues mount and the fixable becomes the end for the car engine, People are no different. Ignoring issues makes treatable, terminal. For Mr. Abdul-Jabbar and the 5,000 new CML patients diagnosed each year, the hope is that medications can keep them treatable for years to come.