Chronic Myeloid Leukaemia

Question 1

COMMS: CML

Answer 1

• Blood is made up of several components such as RBC which carry oxygen, white blood cells which fight infections and platelets which help the blood clot
• These particular blood cells are made in the bone marrow, a spongy material in the middle of many bones
• In blood cancers, some of these blood cells may excessively be produced and released in the blood stream
• In chronic leukaemia, these cancer cells are often more mature than those produced in acute leukaemia. This results in a slower progressing disease as the cells still can function a bit.
• CML is thus named as the white cell affected are from a line of cells known as granulocytes leading to over-production of cells called myeloids.

Question 2

What is the epidemiology/aetiology of CML?

Answer 2

-Occur in middle age and elderly

Question 3

What are the symptoms of CML?

Answer 3

• WEIGHT LOSS, FEVER, SWEATS
• Anaemia – generally feeling tired, SOB on exercise, weakness
• Bleeding and bruising = thrombocytopaenia
• Infection = leukopaenia

Question 4

What are the clinical signs of CLL?

Answer 4

OFTEN NONE

• Pallor
• Fever – due to infection
• Petechiae/Bruising – purple spots (rupture small vessel)
• Lymphadenopathy – in lymphoblastic leukaemia
• Hepatosplenomegaly – in lymphoblastic leukaemia

Question 5

What are the investigations of CLL?

Answer 5

BLOODS

• Lymphocytosis
• Anaemia
• Thrombocytopenia
• Decreased LEUKOCYTE ALKALINE PHOSPHATASE

BLOOD FILM
-Neutrophilia; WBCs bigger, more mature and blast

BIOPSY

• Bone marrow + cytology (Associated with PHILADELPHIA chromosome)
• Lymph node

Question 6

What is the management of CLL?

Answer 6

SUPPORTIVE

• Blood transfusions
• Antibiotics

CURATIVE

• IMATINIB (tyrosine kinase inhibitor)
• Hydroxyurea
• Interferon-alpha
• Splenectomy
• Allogeneic bone marrow transplantation