Chronic Myeloid Leukemia (CML)

Presentation :

• Many have weight loss, abdominal fullness (splenomegaly), fatigue, or fever
• Can present with asx neutrophillia
• Two phases of disease: chronic (<20% myeloblasts) and blast (≥20% myeloblasts)
  • Blast phase is technically a secondary Acute Myeloid Leukemia (AML)

Pathophysiology :

• Driven by BCR/ABL (9:22) translocation
  • Results in constitutive tyrosine kinase activation

Diagnostics :

• BCR/ABL detected by routine cytogenetics, FISH, or rtPCR.
  • At diagnosis, testing peripheral blood is as accurate as bone marrow samples.

Treatment :

• Start treatment at time of diagnosis
• Tyrosine kinase inhibitors (TKIs) are first-line treatment
  • TKI resistance or evidence of disease progression despite treatment should raise suspicion of nonadherence or development of new mutations
• Interferon-α can be used in pregnancy

Prognosis: