Selina M. Luger, MD
Last Modified: November 1, 2001
Dear OncoLink "Ask the Experts,"
I have a friend who is very worried about his adult daughter because his wife died from chronic myelogenous leukemia several years ago. He fears that it could be hereditary and wants to know if/who his daughter should see. Can you give me advice?
Selina M. Luger, MD, Director of the Leukemia Program and Assistant Professor of Medicine at the University of Pennsylvania, responds:
There is no evidence that Chronic Myelogenous Leukemia (CML) is hereditary. Although there is an abnormal gene caused by the presence of the Philadelphia chromosome in this disease, this is not something that a parent transmits to a child at birth. This can be confusing at times to patients. The abnormal gene/chromosome develops in the cells as they become leukemic. They are not part of the DNA/genes that are present at the time of reproduction. This is different from other cancers, which are caused by genes that run in the family that predispose someone to develop breast or colon cancer. Please reassure your friend that his daughter is not at any increased risk of developing CML and that she does not need to see any special physician.
We usually choose to treat patients with chemotherapy if and when they develop (1) low red blood cell or platelet counts (2) bothersome, dangerous or painful enlarged lymph nodes (3) large liver or spleen (4) bothersome fevers, chills, sweats or night sweats.
With respect to the white blood count, some physicians may choose to treat if the count is doubling rapidly, and at times just on the basis of the high white blood count (definitions of high differ greater than 100,000, 200,000, or 250,000).
Sometimes doctors may choose to give the patient treatments other than chemotherapy for some of these manifestations, such as steroids for a low platelet count or immunoglobulin treatment for frequent infections. Some patients receive radiation therapy for enlarged lymph nodes or large spleen.
We generally have talked about CLL as treatable, because in general we try to just keep the disease under control so that it does not cause any problems. Traditional therapies have not been shown to be able to get rid of the disease. However newer treatments and agents continue to become available and time will tell us if any of these succeed in actually getting rid of the disease in patients; something that would obviously be desirable if we could do so without too much risk or undesirable toxicity.