Treatment Abroad – Find Verified Clinics, Reviews & Prices

Nicotine dependence is an addiction to nicotine found in tobacco and vape products. It combines physical and psychological cravings, making it hard to quit despite health risks. How it develops Nicotine quickly reaches the brain and triggers dopamine release, creating feelings of reward. Over time, the body builds tolerance and needs more nicotine. When use stops, withdrawal symptoms appear, such as restlessness or irritability. Signs and symptoms Strong and repeated cravings for nicotine. Difficulty controlling or reducing use. Withdrawal symptoms like agitation, restlessness, and irritability. Continued use despite health or social problems. Relying on nicotine as part of daily routines or to cope with stress. Contributing factors Starting nicotine use at a young age raises the risk of dependence. Genetics can affect vulnerability to addiction. Growing up around parents or peers who smoke increases the likelihood of developing dependence. What to do Quitting often requires support. Treatment options include Nicotine Replacement Therapy (NRT), counseling, and support groups.

The bone marrow plays a critical role in the body’s ability to defend itself by producing blood cells. In healthy individuals, the bone marrow generates stem cells, which mature into: White blood cells (fight infection) Red blood cells (carry oxygen) Platelets (help blood clot) Leukemia develops when abnormalities occur in these stem cells, leading to uncontrolled production of abnormal white blood cells that circulate in the bloodstream and interfere with normal blood cell formation. What Is Chronic Myeloid Leukemia? Chronic myeloid leukemia (CML)—also called chronic granulocytic leukemia or chronic myelogenous leukemia—is a rare cancer of the bone marrow that primarily affects myeloid white blood cells. CML can occur at almost any age, but it is most commonly diagnosed in middle-aged and older adults. In CML, the bone marrow produces excessive numbers of immature myeloid cells, known as blasts, which crowd out healthy blood cells and disrupt normal blood function. Myeloid cells include: Granulocytes Monocytes Macrophages Dendritic cells When produced in abnormal quantities, these cells can lead to the development of CML. Phases of Chronic Myeloid Leukemia The term “chronic” refers to the disease’s typically slow progression. However, CML can advance into a more aggressive leukemia if not adequately controlled. CML is divided into three phases: 1. Chronic Phase Most patients are diagnosed during this phase Often discovered during routine blood tests Few or no symptoms Usually well controlled with medication 2. Accelerated Phase Increased number of immature blood cells Worsening symptoms Enlarged spleen Low red blood cell count Abnormal white blood cell levels May occur due to drug resistance 3. Blast Phase (Blast Crisis) Large numbers of immature blast cells Symptoms resemble acute leukemia High risk of infection, bleeding, and shortness of breath Can transform into acute myeloid leukemia (AML) Requires immediate medical treatment Relapsed CML Some patients may experience relapse, even after achieving remission. This can occur when leukemia cells develop resistance, often due to mutations in the BCR-ABL1 gene. Treatment for relapsed CML focuses on returning the disease to the chronic phase, most commonly using targeted therapy with tyrosine kinase inhibitors (TKIs). Causes of CML CML is caused by a genetic mutation in bone marrow stem cells. The hallmark of the disease is the Philadelphia chromosome. The Philadelphia Chromosome Results from a reciprocal translocation between chromosome 9 and chromosome 22 Produces an abnormal gene called BCR-ABL BCR-ABL creates a protein called tyrosine kinase This protein causes uncontrolled growth of abnormal white blood cells The Philadelphia chromosome develops after birth and is not inherited. Risk Factors for CML Risk factors increase the likelihood of developing cancer but do not guarantee it. Known risk factors include: Age: Average age at diagnosis is around 64 Radiation exposure: Seen in survivors of atomic bomb exposure and certain radiation-treated conditions Gender: More common in men Philadelphia chromosome: Present in nearly all CML cases CML is extremely rare in children and adolescents. Symptoms of CML CML can take years to develop and is often asymptomatic in early stages. When symptoms occur, they may include: Fatigue and weakness Shortness of breath during routine activity Pale or dull skin Fullness or discomfort in the left upper abdomen (enlarged spleen) Night sweats Fever Unintentional weight loss Bone pain Loss of appetite Easy bleeding or bruising Potential Complications Complications of CML may include: Anemia due to low red blood cell production Enlarged spleen Increased risk of secondary cancers, including thyroid, lung, stomach, prostate, and small bowel cancers Diagnosing Chronic Myeloid Leukemia Many patients are diagnosed incidentally after abnormal blood test results. Diagnosis involves specialized blood and bone marrow testing, analyzed by hematopathology experts. Diagnostic tests include: Complete blood count (CBC) with differential Peripheral blood smear Bone marrow aspiration and biopsy Cytogenetic analysis to detect the Philadelphia chromosome Fluorescence in situ hybridization (FISH) Quantitative polymerase chain reaction (qPCR) to measure BCR-ABL1 gene levels qPCR is the most sensitive test and is also used to monitor treatment response. Treatment Options for CML Treatment depends on disease phase, genetic findings, and overall health. Common treatment options include: Targeted therapy (Tyrosine Kinase Inhibitors) Blocks the BCR-ABL protein driving leukemia growth Chemotherapy Slows or stops leukemia cell division Radiation therapy Used in specific situations, such as spleen enlargement Bone marrow (stem cell) transplant Considered when drug therapy is unsuccessful CAR-T cell therapy Primarily used for other leukemias (e.g., ALL), but part of advanced immunotherapy programs Comprehensive Care and Quality of Life At Sheba, treatment extends beyond medication. Patients receive multidisciplinary support from: Hematologists and oncologists Nurses and transplant specialists Social workers and psychologists Nutritionists and supportive care teams The goal is not only to treat the disease but to preserve quality of life, emotional well-being, and long-term health. Living with Chronic Myeloid Leukemia CML is often a long-term condition. Even with a good prognosis, living with a chronic cancer can be emotionally challenging. Some patients require lifelong monitoring and treatment, which can complicate future planning. You do not have to face CML alone. With expert care, modern targeted therapies, and strong support systems, many people with CML lead long, productive, and fulfilling lives.

Myelodysplastic syndromes (MDS) are a group of bone marrow disorders in which the marrow fails to produce sufficient healthy blood cells. These conditions arise from mutations in hematopoietic stem cells, leading to ineffective blood formation and the accumulation of immature or abnormal cells. As a result, patients may experience anemia, infections, and bleeding. Although the exact cause of these mutations is often unknown, MDS has been linked to advanced age, genetic predisposition, environmental exposures, and prior chemotherapy or radiation therapy. MDS is considered rare, with an estimated incidence of 4 per 100,000 people annually, though rates are significantly higher in individuals over 60. In some cases, MDS can progress to acute myeloid leukemia (AML). Types of Myelodysplastic Syndromes MDS is classified based on the number of affected blood cell lines, the presence of abnormal cells, and genetic findings: MDS with Single Lineage Dysplasia (MDS-SLD): One blood cell type is dysplastic, usually associated with cytopenia. MDS with Multilineage Dysplasia (MDS-MLD): Two or more blood cell lines are affected, often causing more severe symptoms. MDS with Ring Sideroblasts (MDS-RS): MDS-RS-SLD – ring sideroblasts with single lineage dysplasia MDS-RS-MLD – ring sideroblasts with multilineage dysplasia MDS with Excess Blasts (MDS-EB): MDS-EB1 – 5–9% blasts in blood or 5–10% in marrow MDS-EB2 – 10–19% blasts in blood or 10–20% in marrow MDS with isolated del(5q): Characterized by a chromosome 5 deletion, typically with anemia and normal or elevated platelets. MDS, Unclassifiable (MDS-U): Does not meet criteria for other categories. Each subtype carries a variable risk of progression to AML. Causes and Risk Factors Key risk factors include: Age (most cases occur after 60) Environmental exposures (benzene, pesticides, tobacco smoke) Prior cancer therapy (therapy-related MDS) Inherited bone marrow failure syndromes Rare familial genetic predisposition Lifestyle factors such as smoking and alcohol use Symptoms of MDS Symptoms reflect low or dysfunctional blood cell production: Anemia: fatigue, weakness, shortness of breath, pallor Leukopenia / neutropenia: recurrent or severe infections Thrombocytopenia: easy bruising, bleeding, prolonged clotting Severity ranges from mild to life-threatening and significantly impacts quality of life. Diagnosis Diagnosis requires a comprehensive hematologic evaluation: Complete blood count (CBC) Peripheral blood smear Bone marrow aspiration and biopsy Cytogenetic and molecular genetic testing Flow cytometry for cellular characterization These tests allow accurate classification, prognostication, and treatment planning. Treatment Options Treatment is personalized based on MDS risk level, age, health status, and goals of care. Lower-Risk MDS Supportive care (blood and platelet transfusions) Erythropoiesis-stimulating agents (ESAs) Iron chelation therapy Immunosuppressive therapy in selected cases Higher-Risk MDS Hypomethylating agents (azacitidine, decitabine) Chemotherapy Allogeneic stem cell transplantation (the only curative option) Participation in clinical trials Living with MDS Managing MDS involves addressing both physical and emotional challenges. Regular follow-up, symptom control, nutritional support, and psychological care are essential. Palliative and supportive services play a key role in maintaining quality of life. Expert Care at Sheba Medical Center The Hemato-Oncology Department at Sheba Medical Center specializes in the diagnosis and treatment of myelodysplastic syndromes, offering advanced molecular diagnostics, personalized therapies, and access to innovative clinical trials. Sheba’s multidisciplinary team is committed to delivering state-of-the-art care with compassion, recognizing that every MDS journey is unique.