Q&A session – July 19, 2009

Question and Answer Session 
held at Adyar Cancer Institute – Chennai
on the 19th of July 2009

Question1. What is CML?
Answer : CML( Chronic Myeloid Leukemia) is a cancer of White blood cells, characterized by replacement of the bone marrow with malignant, leukemic cells. Many of these leukemic cells can be found circulating in the blood and can cause enlargement of the spleen, liver and other organs.
Question 2: What causes CML?
Answer : Each human cell contains 23 pairs of chromosomes. Most cases of CML start when a “swapping” (translocation) of chromosomal material (DNA) occurs between chromosomes 9 and 22 during cell division. Part of chromosome 9 goes to 22 and part of 22 goes to 9. This gives rise to the Philadelphia chromosome, which is an extra short chromosome 22. The Philadelphia chromosome is found in the leukemia cells of almost all patients with CML.
But what causes the swapping of chromosomal material between chromosomes 9 and 22 during cell division is yet to established
Question 3 : If a father or a mother has CML , will the children also inherit the illness ?
Answer : There is no established evidence to conclude that CML is inherited by progeny
Question 4 : Can CML be prevented ?
Answer : There is no known way to prevent most cases of CML. Although many types of cancer can be prevented by lifestyle changes to avoid certain risk factors, this is not true for chronic myeloid leukemia (CML).
Question 5 :  I am taking Glivec , but I have this side effect of water retention . What should I do?
Answer: Water retention is one of the most common side effects of Glivec. The recommended course of handling this is to reduce salt intake. You can consult your doctor who may start you on medications if indicated.
Question  6 : I have severe muscular cramps in the leg , accompanied with pain in the legs what should I do ?
Answer:  The common way to handle this side effect of Glivec is to keep taking short walks and not be in a sedentary position. With time the pain should reduce, if persists please consult your doctor
Question 7 : My Hemoglobin(Hb) count is low , are there are preferred medications to increase the Hb value  ?
Answer : There is no recommended course to increase Hb . In some cases your doctor may prescribe some Iron tablets. If persisting, consult your doctor.
Question 8 : Can I take other medications like Paracetomol , Calpol with Glivec ?
Answer : This is not advisable. Any other medications along with Glivec should only be taken after consultation with your doctor
Question 9 :  When can I stop taking Glivec ?
Answer :Glivec therapy as of today has to be continued lifelong. Pending glivec should be done only in consultation with your doctor . In some cases , when the side effects are very prominent , the doctor may advise some Glivec holiday period , in which case please inform Beena the South Max Station Co-ordinator .
The doctor will advise you when to resume the medicine, so please follow doctor’s advise
Question 10 : Can I undertake any surgery like tooth extraction while on Glivec
Answer : Yes , you can . But please talk to your doctor who is treating you for CML and also inform the other doctor who is treating for a non-CML related ailment that you are a CML patient on Glivec
Question 11 : My BCR-Abl value keeps fluctuating from 0.04 to 0.02 while on Glivec , should I increase my dosage of Glivec ?
Answer :  Not recommended . Your treating doctor will be able to advise you on this. However, as a practice the dosage is not increased on such variations. Your doctor will decide on the same as per the guidelines.
Question 12 : I am married woman , who is on Glivec . Can I get pregnant ?
Answer :  There is no broad answer to this question and it cannot be generalized .As a practice women are not advised to take Glivec when they are panning /during pregnancy . Glivec is known to cause congenital anomalies and therefore it is not recommended to continue Glivec while pregnant.
In such cases some alternate treatment is prescribed for the women with CML . These should be deeply discussed amongst partners and with doctors before a decision is taken
Question 13 : Can a male member who is on Glivec , father a child ?
Answer : There is no established evidence of any harm to the child if its fathered by a person who is on Glivec . However, discussion with doctor is recommended before a decision is made on the same
Question 14 : I was diagnosed with CML, while I was pregnant . Will my child also be CML affected ?
Answer: No genetic inheritance of CML is not known.
Question 15 : I have Urticaria once in a while for which I require Cetrizine or Atrax . Is it adviced to continue with Glivec when I d so ?
Answer : Yes, you can continue with Glivec
Question 16:  I don’t have money to do blood test . Govt Hospital says they cannot do this test free of cost . Since I am not financially well-off , I am not able to do the test (CBC) . By not doing the test will I get Glivec ?
Answer :  Yes you can still continue to get the medicine. There are assistant groups available in Adyar Cancer Institute Chennai . Please contact Ms.Geetha at Adyar Cancer Institute or your doctor and they will be more than glad to help you