Many people who have chronic myeloid leukemia (also known as chronic myelogenous leukemia or CML) do not show symptoms of the disease at first and may be diagnosed only after abnormal results are noticed on a routine blood test. Symptoms will likely become apparent over time, although several symptoms of CML are the same as many other conditions.

Symptoms of CML

CML shares many common symptoms with other types of leukemia. Most of the symptoms occur as a result of abnormal levels of healthy blood cells.

Symptoms of CML include:

• Fatigue
• Weakness
• Fever
• Shortness of breath while performing basic, everyday activities
• Night sweats
• Unexplained weight loss
• Bruising or bleeding easily
• Pain in the upper left side of the belly

When there are too many leukemia cells in the bone marrow, new cells cannot be made. The bone marrow is responsible for making healthy red blood cells, white blood cells, and platelets. Without enough of these blood cells, many problems can develop, including:

• Anemia (lack of red blood cells), which can lead to fatigue, weakness, and shortness of breath
• Neutropenia (low levels of the immune cell neutrophils), which increases the risk of severe bacterial infections
• Leukopenia (low levels of normal, noncancerous white blood cells known as leukocytes), which also increases the risk of infections
• Thrombocytopenia (low levels of platelets), which can lead to easy bleeding or bruising, severe and frequent nosebleeds, and bleeding gums

Some people with CML may have high levels of abnormal white blood cells or platelets. However, these cells cannot fight infections the way normal, healthy white blood cells and platelets do. This leads to bleeding and infection risk.

Symptoms of CML by Phase

There are three phases of CML: chronic phase, accelerated phase, and blast phase (also known as blast crisis phase).

Chronic Phase CML

Most cases of CML are diagnosed in the chronic phase. People with chronic phase CML may or may not show symptoms, which can make it difficult to diagnose. It is usually caught during routine blood tests that find an increased number of white blood cells. If left untreated, chronic phase CML can progress to accelerated or blast phase CML.

Accelerated Phase CML

People with accelerated phase CML will have changes in their blood counts and worsening symptoms. More blasts (immature blood cells) are found in the blood and bone marrow, and symptoms like anemia can worsen. During this phase, CML cells grow faster and can lead to an enlarged spleen (splenomegaly), fatigue, weight loss, and fever. Accelerated phase CML will eventually progress to blast phase CML.

Blast Phase CML

People with blast phase CML present similarly to those with acute myeloid leukemia (AML). Signs and symptoms include:

• Very high white blood cell count
• Joint and bone pain due to the spread of leukemia cells to other tissues and organs
• Abdominal pain
• Bleeding
• Infections
• A feeling of fullness, poor appetite, and weight loss due to the enlarged spleen pressing on the stomach
• Fever
• Shortness of breath
• Fatigue

Blood Tests for Leukemia

If you are experiencing any symptoms of CML, talk to your doctor. They will perform several lab tests to confirm a diagnosis. These include blood tests and a bone marrow biopsy.

A complete blood count (CBC) measures the levels of different blood cells, including red and white blood cells and platelets. A blood smear is also done, where a sample of blood is put on a glass slide and looked at under a microscope. In some cases, people with CML will have too many immature cells known as blasts or myeloblasts.

Leukemia begins in the bone marrow, so it is vital to check for cancer cells there. A thin, hollow needle is inserted into the bone and the marrow inside, and samples are taken to be examined under a microscope.

If you’re diagnosed with leukemia and begin treatment, you may also notice side effects that may seem like symptoms.

CML Symptom or Treatment Side Effect?

All medications come with side effects, and it can be difficult to tell the difference between these side effects and symptoms of a condition. CML is commonly treated with tyrosine kinase inhibitors (TKIs), which are a class of drugs that target the abnormal BCR-ABL1 gene found in leukemia cells. These include:

• Gleevec (imatinib)
• Tasigna (nilotinib)
• Sprycel (dasatinib)
• Bosulif (bosutinib)
• Iclusig (ponatinib)

Potential side effects of these TKIs include:

• Nausea
• Muscle pain
• Fatigue
• Diarrhea
• Swelling or fluid buildup
• Low blood cell counts
• Abdominal pain
• Headache

In addition, chemotherapy can be used to treat CML. Chemotherapy drugs can include Hydrea (hydroxyurea), Cytoxan (cyclophosphamide), and Synribo (omacetaxine). Symptoms of CML and side effects of chemotherapy also overlap, including:

• Nausea and vomiting
• Loss of appetite
• Low blood cell counts

Talk With Others Who Understand

MyLeukemiaTeam is the social network for people with leukemia and their loved ones. More than 8,600 members come together to ask questions, give advice, and share their stories with others who understand life with leukemia.

Do you have chronic myeloid leukemia? What were your symptoms? Share your experience in the comments below, or start a conversation by posting on MyLeukemiaTeam.