Chronic Myeloid Leukaemia

Question 1

what is chronic myeloid leukaemia

Answer 1

malignant clonal disease characterised by proliferation of granulocyte precursors in the bone marrow and blood

Question 2

how do you distinguish between CML and AML

Answer 2

CML has slower progression than AML

Question 3

epidemiology of CML

Answer 3

CML is most common in middle-aged patients, with males slightly more affected

Question 4

aetiology of CML

Answer 4

chromosomal translocation between chromosomes 9 and 22 to form the Philadelphia chromosome

Question 5

can CML be an incidental finding

Answer 5

yes, some patients are asymptomatic and are diagnosed on routine bloodwork

Question 6

what features will a patient with CML present with

Answer 6

CML usually presents with weight loss, tiredness, fever, sweating, shortness of breath, left UQ discomfort.

Common signs include massive splenomegaly (>75%), pallor, bleeding (due to thrombocytopenia), and gout

(bone marrow failure will present with bleeding and pallor)

Question 7

what investigations will be done for CML

Answer 7

FBC, peripheral blood smear and bone marrow biopsy

results;
Blood tests commonly show leukocytosis, in particular raised myeloid cells which include: neutrophils, monocytes, basophils, and eosinophils. Bone marrow analysis shows similar findings.

Question 8

what are the phases of CML

Answer 8

The ‘chronic phase’ of the disease may transform to an ‘accelerated’ or ‘blast’ phase in 5% to 10% of patients despite treatment with a tyrosine kinase inhibitor, the latter resulting in acute myeloid or acute lymphoblastic leukaemia

Relatively stable chronic phase (4-6 yr duration)
Accelerated phase (3-9 months)
Acute leukaemia phase - blast transformation

Question 9

how can CML be managed

Answer 9

chemotherapy

Question 10

prognosis of CML

Answer 10

median survival is 5-6 years