Chronic myeloid leukemia

First appointment

Your first appointment at Fred Hutchinson Cancer Center is a time for you and your hematologist-oncologist to meet. You might meet your advanced practice provider, too. You will talk about your diagnosis, disease outlook and likely treatment. This visit is also a time for us to start getting to know you as a person. This helps us fit our recommendations to you. Together, you and your care team will decide what needs to happen next.

We encourage you to bring a family member or friend to your first appointment (and any future visits).

Hematologist A physician who specializes in diseases of the blood and blood-forming tissues.

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What to Expect

Your first appointment usually lasts about one hour. Here’s what you can expect to happen.

Confirming your diagnosis

Most of our new patients have already had blood tests that show they have chronic myeloid leukemia (CML). Many were recently diagnosed. Others have had CML treatment elsewhere and are looking for new options. If you haven’t had the blood tests you need, we may ask you to come in for these before your first appointment.

We start by checking your diagnosis. An experienced Fred Hutch hematopathologist looks carefully at your pathology slides. Knowing details about your CML is important because it helps your doctor predict how your disease might behave and which treatments will likely work best for you.

Our hematopathologists may run more tests on your blood or bone marrow to confirm your diagnosis or look for features of your CML that matter for your care. At your first appointment, your doctor will have your results and go over them with you.

Talking about your disease

Your doctor will explain what CML is and how it typically behaves over time. They will talk with you about how the disease is affecting your body, and they will describe what happens for most people in your situation with or without treatment.

Doctors group CML into three phases — chronic, accelerated and blast — based mainly on the percentage of immature white blood cells (blasts) in the blood and bone marrow. Knowing the phase helps your team choose the best treatments for you. Your doctor will explain what your CML phase means.

Most new patients are in the chronic phase. In this phase, the percentage of blasts is abnormal but low. In the accelerated phase, the percentage is higher, and you might have other signs and symptoms. In the blast phase, the percentage is even higher, and the disease acts more like acute leukemia.

Discussing your treatment

The goal of CML care is to give you a normal lifespan with the best possible quality of life. The treatment we recommend for you will depend on your CML phase and many other things, like your age and health. If your CML has already been treated elsewhere, we will also consider which therapies you had, how your disease responded and if you had side effects.

Based on your test results so far (and any previous treatment), your doctor will explain the treatments you are likely to need. If you need any other tests to tell us more about your disease, we will talk about your treatment again in more detail after we have the results.

These appointments are also a time for you to tell us about yourself. Each patient and family has their own needs and preferences. We want to get to know you so we understand the best way to care for you.

Answering your questions

Starting with your first appointment (and after), we are here to answer your questions. We want to help you understand as much as you want to know about your disease, your treatment and how care happens at Fred Hutch. We invite you to bring a friend or family member with you to help keep track of your questions and the information that your team gives you.

We also encourage you to talk with your care team about your hopes and concerns. Knowing more about you helps your team recommend the right treatment for you.

Before you leave, we will make sure you know what is going to happen next and how you can reach us if you have questions later. We will also schedule your next visit.

Tests for CML

To diagnose CML, figure out the phase of your disease, predict the outlook, plan your treatment and check how well treatment works, we will need to do blood and bone marrow tests and imaging tests.

Blood and marrow tests show your levels of healthy blood cells and leukemia cells. They also give us details about your leukemia cells that affect your treatment plan. Imaging tests provide information about how CML is affecting your organs.

Bone marrow The soft, spongy material in the center of your bones that produces all your blood cells, such as white blood cells, red blood cells and platelets. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Blood tests

Blood tests for CML include:

Complete blood count (CBC)
Blood chemistry
Peripheral blood smear
Cytogenetic tests
Fluorescence in situ hybridization (FISH)
Polymerase chain reaction (PCR)

Fluorescence in situ hybridization A laboratory method used to look at genes or chromosomes in cells and tissues with the help of fluorescent dye. It is used to help diagnose diseases such as cancer and to help plan treatment. A laboratory method used to look at genes or chromosomes in cells and tissues. Pieces of DNA that contain a fluorescent dye are made in the laboratory and added to a cell or tissue sample. When these pieces of DNA bind to certain genes or areas on chromosomes in the sample, they light up when viewed under a microscope with a special light. FISH can be used to identify where a specific gene is located on a chromosome, how many copies of the gene are present and any chromosomal abnormalities. It is used to help diagnose diseases such as cancer and to help plan treatment. Peripheral blood smear A procedure in which a sample of blood is viewed under a microscope to count different circulating blood cells (such as red blood cells, white blood cells or platelets) and see whether they look normal. Polymerase chain reaction A laboratory method used to make many copies of a specific piece of DNA from a sample. It allows very small amounts of DNA to be amplified so they can be detected. A laboratory method used to make many copies of a specific piece of DNA from a sample that contains very tiny amounts of that DNA. Polymerase chain reaction allows these pieces of DNA to be amplified so they can be detected. Polymerase chain reaction may be used to look for certain changes in a gene or chromosome, which may help find and diagnose a genetic condition or a disease, such as cancer. It may also be used to look at pieces of the DNA of certain bacteria, viruses or other microorganisms to help diagnose an infection.

Bone marrow aspiration and biopsy

After numbing the area so there is no pain, a doctor uses a hollow needle to take a sample of marrow (bone marrow aspiration) and a small piece of bone (bone marrow biopsy). A pathologist checks these samples for signs of cancer. Many of the same tests done on your blood can also be done on your marrow.

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose.

Imaging tests

Imaging tests that we use to check if CML is affecting your organs include:

CT (computed tomography) scan
MRI (magnetic resonance imaging)
Ultrasound

Computed tomography A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are used to create three-dimensional (3-D) views of tissues and organs. A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create three-dimensional (3-D) views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. This scan may be used to help diagnose disease, plan treatment or find out how well treatment is working. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Magnetic resonance imaging A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or X-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints and the inside of bones.

Resources for Patients and Caregivers

Here are tips about how to prepare for your first appointment at Fred Hutch and what to bring.

Preparing for Your First Visit

Resources for New Patients

Just like every patient’s situation is different, every caregiver may be asked to help with different tasks. Learn how you can offer support during a first visit.

For caregivers: Caregiving at the first appointment

As a caregiver, you can give your loved one both emotional and practical support for their first appointment. Ask them if you can help with things like these:

Helping them manage their stress, worry or other feelings.
Planning how to get to and from the appointment, what time to leave home and where to park.
Making a list of questions they want to ask the physician. Fred Hutch’s Guide to Your Care (PDF) has a list of questions they may want to ask the care team. At the appointment, make sure that all their questions get answered.
Taking notes during the visit. The physician will be giving a lot of details, which can be hard to remember later without notes.

Resources for Caregivers

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