Chronic Myeloid Leukaemia (CML)

Question 1

This has a similar pathophysiology to AML. There is clonal proliferation of myeloid stem cells.

What happens to them making CML different from AML?

Answer 1

They differentiate into granulocytes

Question 2

There is a chromosomal translocation. What is this chromosome called?

Answer 2

Philidelphia chromosome

Translocation between chromosome 9 and 22

Question 3

S+S:

Often asymptomatic.

Systemic symptoms? - 5

Why do they get abdominal discomfort and early satiety?

Cytopenia:

• Signs of anaemia?
• Signs of thrombocytopenia?

Why is urate raised in leukaemia?

What will raised urate cause?

Answer 3

Tired 
Malaise
Weight loss
Fever 
Night sweats 

Due to splenomegaly (can be massive)

Pallor - SOB etc.

Bleeding or bruising including epistaxis

Uric acid in serum (S-UA) is produced by the breakdown of the cellular nucleic acids of leukaemia cells, and may be a marker of disease aggressiveness.

Gout

Question 4

Investigations:

FBC:

• Why are WBC raised?
• What type of WBC is typically raised in CML?

Blood film - what type of cells will it show?

How is it diagnosed?

Answer 4

As stem cells in bone marrow begin to divide and multiply, they develop into all the needed types of blood cells. In patients with leukaemia, cell growth goes “haywire,” and there is a rapid growth of abnormal white blood cells.

Basophils - one of the few triggers so think CML if you see a raised basophil

Granulocytes

Bone marrow biopsy

Question 5

Management:

Same as always!

Tyrosine kinase inhibitor - slows or stops cancer multiplying - some patients can come off it when they reach remission

Answer 5

Management:

Same as always!