Most of patients with chronic myelogenous leukemia are diagnosed in the chronic phase and then progress to the accelerated and blast phases in 3 to 5 years.

The diagnosis of chronic myeloid leukemia is based on the histopathologic findings in the peripheral blood and the presence of the Philadelphia chromosome in bone marrow cells [2] [4].

The clinical symptomatology of chronic myelogenous leukemia may be insidious. The disease is often discovered with routine blood work in the chronic phase, when an elevated white blood cell (WBC) count is revealed or when an enlarged spleen is found in a general physical examination.

The symptoms change as the disease progresses from chronic, to accelerated, and finally to blast.

Signs and symptoms in the chronic phase are [2]:

• Fatigue, weight loss, loss of energy, decreased exercise tolerance
• Low-grade fever and excessive sweating
• Elevated white blood cell (WBC) count
• Splenomegaly
• Decreased appetite and food intake
• Left upper quadrant abdominal pain from splenomegaly
• Hepatomegaly

Signs and symptoms of progressive disease [2] [3]:

• Bleeding, petechiae, and ecchymoses
• Bone pain and fever
• Increasing anemia, thrombocytopenia, basophilia,
• Rapidly enlarging spleen

The manifestations of blast crisis are similar to those of acute leukemia. Treatment is ineffective in this stage, and most patients succumb to the disease once they reach this phase and survival is 3-6 months.

• Splenomegaly

  Patients with splenomegaly and abnormally high leukocyte counts were first recognized in France, Germany, and Scotland in the 1840s. [ncbi.nlm.nih.gov]

  Initially, pallor, bleeding, easy bruising, and lymphadenopathy are unusual, but moderate or occasionally extreme splenomegaly is common (60 to 70% of cases). With disease progression, splenomegaly may increase, and pallor and bleeding occur. [merckmanuals.com]

• Massive Splenomegaly

  Here, we report a case of aCMLin a 5-month baby who presented with massive splenomegaly. The diagnosis was in accordance with the WHO criteria established in 2008. [ncbi.nlm.nih.gov]

  Massive splenomegaly is characteristic and may cause left hypochondral pain. The condition usually remains stable for years and then transforms to a more overtly malignant disease. [gpnotebook.co.uk]

  Spleen size roughly correlates with the WBC count and massive splenomegaly corresponds to poor prognosis. Hepatomegaly is also common, but lymphadenopathy is usually not present. [lecturio.com]

• Easy Bruising

  There is a lack of red blood cells, leading to anemia, and platelets, leading to bleeding tendencies and easy bruising. CML epidemiology CML is a relatively uncommon type of cancer. [news-medical.net]

  Initially asymptomatic, CML progression is insidious, with a nonspecific “benign” stage (malaise, anorexia, weight loss) eventually giving way to accelerated or blast phases with more ominous signs, such as splenomegaly, pallor, easy bruising and bleeding [msdmanuals.com]

  Thrombocytopenia is a condition when there is a low number of platelets which can cause bleeding and easy bruising with no apparent cause. Low numbers of all three blood cell counts is called pancytopenia. [llscanada.org]

  It can lead to easy bruising or bleeding, with frequent or severe nosebleeds and bleeding gums. Some patients with CML actually have too many platelets (thrombocytosis). [cancer.org]

• Fatigue

  Patients usually present with fatigue, weight loss, anemia, night sweats, and splenomegaly. [icd9data.com]

  Blast crisis can lead to complications, including infection, bleeding, fatigue, unexplained fever, and kidney problems. Chemotherapy can have serious side effects, depending on the drugs used. Avoid exposure to radiation when possible. [nlm.nih.gov]

  Signs of infection include fever and fatigue. A shortage of red blood cells is called anemia. Symptoms include general weakness and fatigue. Anemia makes your heart work harder. [healthline.com]

  On initial presentation she reported fatigue, night sweats, and early satiety, and was found to have a white blood cell (WBC) count of 69.3 × 109 /L and platelet count of 366 × 109 /L. [ncbi.nlm.nih.gov]

  Complications of chronic of chronic myeloid leukemia may include the following: Fatigue due to anemia (decreased number of red blood cells). [symptoma.com]

• Fever

  Common symptoms include fever (even without infection), bone pain, and a swollen spleen. Untreated CML leads to the blast crisis phase. Bleeding and infection may occur due to bone marrow failure. [nlm.nih.gov]

  Initially asymptomatic, CML progression is insidious, with a nonspecific “benign” stage (malaise, anorexia, weight loss) eventually giving way to accelerated or blast phases with more ominous signs, such as splenomegaly, pallor, easy bruising and bleeding, fever [msdmanuals.com]

  Fever, enlarged lymph nodes, an increase in immature white blood cells, and certain skin rashes are usually signs of advanced disease. [merck.com]

  In December 2015, he presented at our hospital with fever and lumbago. A complete blood count revealed a white blood cell count of 30,500/µL with 60% blasts, leading to diagnosis of SBP. [ncbi.nlm.nih.gov]

• Anemia

  We report a case of a chronic myeloid leukemia patient showing progressive bone marrow fibrosis and anemia during imatinib therapy. [ncbi.nlm.nih.gov]

  Patients usually present with fatigue, weight loss, anemia, night sweats, and splenomegaly. [icd9data.com]

  There is a lack of red blood cells, leading to anemia, and platelets, leading to bleeding tendencies and easy bruising. CML epidemiology CML is a relatively uncommon type of cancer. [news-medical.net]

  Complications of chronic of chronic myeloid leukemia may include the following: Fatigue due to anemia (decreased number of red blood cells). [symptoma.com]

  CML evolves slowly at the beginning and, without treatment, ends by deteriorating into acute (“blast”) phases similar to Acute Myeloid Leukemia, causing deadly anemia, coagulation impairment or lack of defense against infections. [hybrigenics.com]

• Weight Loss

  Patients usually present with fatigue, weight loss, anemia, night sweats, and splenomegaly. [icd9data.com]

  Initially asymptomatic, CML progression is insidious, with a nonspecific “benign” stage (malaise, anorexia, weight loss) eventually giving way to accelerated or blast phases with more ominous signs, such as splenomegaly, pallor, easy bruising and bleeding [msdmanuals.com]

  People pass through a phase in which they have nonspecific symptoms such as tiredness, loss of appetite, and weight loss. As the disease progresses, the lymph nodes and spleen enlarge, and people may also be pale and bruise or bleed easily. [merck.com]

  You might also experience unexplained weight loss and fever. Blood Leukemia is cancer of the blood. [healthline.com]

  Common features include excessive tiredness (fatigue), fever, and weight loss. Many affected individuals develop an enlarged spleen (splenomegaly), which can cause a feeling of fullness in the abdomen and a loss of appetite. [ghr.nlm.nih.gov]

• Weakness

  However, we were unable to determine the mechanism underlying the dasatinib-associated muscle weakness. [ncbi.nlm.nih.gov]

  It can cause weakness, tiredness, and shortness of breath. Leukopenia is a shortage of normal white blood cells. This shortage increases the risk of infections. [cancer.org]

  They can also affect your fingernails and toenails, making them brittle and weak. Other medications can cause skin problems, such as rash, sensitivity, and itchiness. [healthline.com]

• Respiratory Distress

  Rarely, patients may present with symptoms of leukostasis such as confusion, blurred vision, respiratory distress, thrombosis, headache or priapism, with WBC count usually >500,000/mcl. [lecturio.com]

  This syndrome is associated with respiratory distress, increasing WBC count, pulmonary infiltrates, fever, weight gain, and less commonly effusions, hypotension and renal failure. Management is with discontinuation of ATRA and glucocorticoids. [cancertherapyadvisor.com]

  thoracic and mediastinal disorders Acute respiratory distress syndrome 1/103 (0.97%) 1 Chronic obstructive pulmonary disease 1/103 (0.97%) 1 Epistaxis 1/103 (0.97%) 1 Pulmonary haemorrhage 1/103 (0.97%) 1 Skin and subcutaneous tissue disorders Pyoderma [clinicaltrials.gov]

• Dyspnea

  Patients presenting with symptoms due to the failure of other cell lines often appear with symptomatic anemia (fatigue, dyspnea on exertion, and/or weakness) or petechiae and mucosal bleeding from thrombocytopenia. [cancertherapyadvisor.com]

  Finally, the red blood cell deficiency leads to anemia, which may cause dyspnea and pallor. Some people experience other symptoms, such as feeling sick, having fevers, chills, night sweats, feeling fatigued and other flu-like symptoms. [en.wikipedia.org]

• Abdominal Pain

  Approximately 5 months after the initiation of nilotinib for CML, he developed upper abdominal distension with intermitting abdominal pain, and based on abdominal computed tomography findings, a diagnosis of pneumatosis intestinalis (PI) was made. [ncbi.nlm.nih.gov]

  Some patients may also experience extreme fatigue, shortness of breath, and abdominal pain. Blast crisis closely resembles acute leukemia and has a survival range of three to six months. [nationalcmlsociety.org]

  Symptoms of CML may include: Upper abdominal pain – hepatosplenomegaly Poor appetite – enlarged spleen may compress the stomach Low-grade fever/night sweats – increased metabolism Gout – increased cell turnover → excess purines → broken down to uric acid [geekymedics.com]

  The symptoms of all types of leukemia are generally the same and include: tiredness and weakness swollen lymph nodes recurrent infections (like bronchitis or tonsillitis ) fever easy bruising bone and joint pain abdominal pain (caused by abnormal blood [kidshealth.org]

  The most common symptoms are: Fatigue Frequent infections Enlarged lymph nodes Unexplained fevers Night sweats Bruising and excess bleeding Abdominal pain Bone and joint pain Headaches and other neurological symptoms Unintentional weight loss Because [verywellhealth.com]

• Loss of Appetite

  Chronic myeloid leukemia symptoms Symptoms of CML include: Easy bleeding Unexplained weight loss Fever Loss of appetite Night sweats Pale skin Chronic myeloid leukemia treatment options Treatment for CML may include radiation therapy, chemotherapy, stem [cancercenter.com]

  The lymphoid cells are those white blood cells that help fight viral infections and some bacterial infections Symptoms of CML One of the earliest symptoms of CML includes fatigue, weight loss, loss of appetite, night sweats, anemia, bone pain and easy [news-medical.net]

  If you have any, some, or all, of these symptoms*, please speak with your physician: Pale skin Shortness of breath Tiredness, lethargy Night sweats Unexplained weight loss / loss of appetite Enlarged spleen or liver (upon physician examination) *From [pennmedicine.org]

  People pass through a phase in which they have nonspecific symptoms such as tiredness, loss of appetite, and weight loss. As the disease progresses, the lymph nodes and spleen enlarge, and people may also be pale and bruise or bleed easily. [merck.com]

  […] of appetite, and weight loss. [uihc.org]

• Early Satiety

  On initial presentation she reported fatigue, night sweats, and early satiety, and was found to have a white blood cell (WBC) count of 69.3 × 109 /L and platelet count of 366 × 109 /L. [ncbi.nlm.nih.gov]

  EJ Occasionally, patients with CML have symptoms such as fever, fatigue, sweats, and early satiety due to splenomegaly. However, many patients are asymptomatic at diagnosis. [hematologyandoncology.net]

  Patients may present with non-specific symptoms of low-grade fever, malaise, night sweats, or abdominal fullness and early satiety due to an enlarged spleen. [lecturio.com]

  The large spleen may encroach on the stomach and cause early satiety and decreased food intake. Left upper quadrant abdominal pain described as "gripping" may occur from spleen infarction. [emedicine.medscape.com]

  The most common presenting symptoms are fatigue (usually related to mild to moderate anemia) and modest weight loss (most often due to early satiety from splenomegaly). Fever or bleeding are relatively uncommon. [clinicaladvisor.com]

• Abdominal Fullness

  Splenomegaly, which tends to be present in the blast phase (detailed below), causes abdominal fullness or discomfort, feeling full early when eating (the spleen is pressing on the stomach), and weight loss. [oncolink.org]

  Patients are often asymptomatic early on, with insidious onset of nonspecific symptoms (eg, fatigue, weakness, anorexia, weight loss, night sweats, a sense of abdominal fullness particularly in left upper quadrant, gouty arthritis, symptoms of leukostasis [merckmanuals.com]

  Some patients at this stage have no symptoms or only mild vague ones like fatigue and a feeling of abdominal fullness, and they learn of their disease through a routine blood test. [nytimes.com]

• Abdominal Distension

  Approximately 5 months after the initiation of nilotinib for CML, he developed upper abdominal distension with intermitting abdominal pain, and based on abdominal computed tomography findings, a diagnosis of pneumatosis intestinalis (PI) was made. [ncbi.nlm.nih.gov]

  Abdominal fullness or abdominal distension. Left upper quadrant pain due to splenic infarction. Signs Splenomegaly - the most common physical finding, which may extend towards the right iliac fossa. Hepatomegaly. [patient.info]

  As expected, patients developed the known side effects of imatinib, including edema, muscle cramps, and gastrointestinal disturbances (diarrhea and abdominal pain or distention). [doi.org]

• Tachycardia

  On physical examination, we observed tachycardia, altered mental status, and dehydration. Blood analysis revealed leukocytosis, thrombocytosis, and marked hypercalcemia (18.6 mg/dL). [ncbi.nlm.nih.gov]

  Febrile neutropenia 15/103 (14.56%) 21 Leukocytosis 10/103 (9.71%) 20 Leukopenia 18/103 (17.48%) 64 Lymphopenia 13/103 (12.62%) 39 Neutropenia 48/103 (46.60%) 139 Pancytopenia 15/103 (14.56%) 22 Thrombocytopenia 67/103 (65.05%) 253 Cardiac disorders Tachycardia [clinicaltrials.gov]

• Hepatomegaly

  Hepatomegaly also occurs, although less commonly than splenomegaly. Hepatomegaly is usually part of the extramedullary hematopoiesis occurring in the spleen. [emedicine.medscape.com]

  […] are: Fatigue, weight loss, loss of energy, decreased exercise tolerance Low-grade fever and excessive sweating Elevated white blood cell (WBC) count Splenomegaly Decreased appetite and food intake Left upper quadrant abdominal pain from splenomegaly Hepatomegaly [symptoma.com]

  Hepatomegaly is also common, but lymphadenopathy is usually not present. In 25% of cases, patients are asymptomatic and CML is diagnosed on routine blood tests or palpable spleen on physical examination. [lecturio.com]

  […] sweating from hypermetabolism Elevated white blood cell (WBC) count or splenomegaly on routine assessment Early satiety and decreased food intake from encroachment on stomach by enlarged spleen Left upper quadrant abdominal pain from spleen infarction Hepatomegaly [emedicine.com]

• Hepatosplenomegaly

  Due to presenting complaint of bleeding diathesis and absence of hepatosplenomegaly, the case was undiagnosed for CML until the patient reported to us. [ncbi.nlm.nih.gov]

  Symptoms of CML may include: Upper abdominal pain – hepatosplenomegaly Poor appetite – enlarged spleen may compress the stomach Low-grade fever/night sweats – increased metabolism Gout – increased cell turnover → excess purines → broken down to uric acid [geekymedics.com]

  It can also present with symptoms indicative of hepatosplenomegaly and the resulting upper quadrant pain this causes. The enlarged spleen may put pressure on the stomach causing a loss of appetite and resulting weight loss. [en.wikipedia.org]

  […] that Alfred Velpeau in France be credited with the first detailed description of what must have been leukemia in 1827. 11 As a result of astute clinical observations, he described a 63-year old florist and lemonade salesman who presented with gross hepatosplenomegaly [haematologica.org]

• Night Sweats

  Patients usually present with fatigue, weight loss, anemia, night sweats, and splenomegaly. [icd9data.com]

  On initial presentation she reported fatigue, night sweats, and early satiety, and was found to have a white blood cell (WBC) count of 69.3 × 109 /L and platelet count of 366 × 109 /L. [ncbi.nlm.nih.gov]

  Night Sweats Night sweats can be a symptom of cancer, especially blood-related cancers like leukemia. Unlike the common hot flashes or sweating associated with menopause, night sweats related to leukemia are often dramatic. [verywellhealth.com]

  Other symptoms may include excessive sweating (night sweats), weight loss, and an increased sensitivity to warm temperatures. [nationalcmlsociety.org]

• Petechiae

  Other possible symptoms of a blast crisis include: Bruising Excessive sweating (night sweats) Fatigue Fever Pressure under the lower left ribs from a swollen spleen Rash -- small pinpoint red marks on the skin ( petechiae ) Weakness A physical examination [nlm.nih.gov]

  They may also develop petechiae, which are small red and purple spots on the body. These indicate that blood is not clotting properly. Petechiae develop when immature white blood cells crowd out platelets, which are crucial for blood clotting. [medicalnewstoday.com]

  You might also notice tiny red or purple dots due to slight bleeding just under your skin (petechiae). Not everyone with CML is low on platelets. In fact, it’s possible that you have too many. This is called thrombocytosis. [healthline.com]

  […] stomach Low-grade fever/night sweats – increased metabolism Gout – increased cell turnover → excess purines → broken down to uric acid Increased susceptibility to infections – ↓ functional immune cells Shortness of breath/fatigue – anaemia Easy bruising/petechiae [geekymedics.com]

• Increased Sweating

  The symptoms of CML during the condition's chronic or accelerated stage include: tiredness loss of appetite weight loss anaemia(fewer red blood cells) increased sweating abnormal or unusual bruising and bleeding bone pain haedaches and visual disturbances [hse.ie]

  More frequently, however, an in-depth medical history reveals a deterioration of well-being, impaired exercise tolerance, loss of appetite, feeling of fullness in the abdomen, weight loss, and increased sweating. [ncbi.nlm.nih.gov]

• Bone Pain

  If you’ve just been diagnosed For your first visit (CMLers only) Please complete this little survey (five questions) - Thank you for your collaboration Search Engine - Enter a topic (For example (imatinib, cure, pleural effusion, bone pain,... ) [cmleukemia.com]

  Bone pain or joint pain because of expansion of the bone marrow from the buildup of white blood cells. Swollen or enlarged spleen due to the e storage of the extra blood cells in the spleen. [symptoma.com]

  Symptoms include those mentioned above, as well as bone pain, infection, acute bruising and bleeding. Bruising and seepage of blood into the skin is a primary feature of this phase. [nationalcmlsociety.org]

  It can also be used to treat bone pain in cases where the leukemia has led to bone damage. It may also be used in preparation for a stem cell transplant. CML can progress, or speed up, and starts to act like an acute form of leukemia. [oncolink.org]

  The lymphoid cells are those white blood cells that help fight viral infections and some bacterial infections Symptoms of CML One of the earliest symptoms of CML includes fatigue, weight loss, loss of appetite, night sweats, anemia, bone pain and easy [news-medical.net]

• Arthralgia

  (facial edema, peripheral edema, arthralgia, GI trouble) * Dasatinib : Pleural effusion 등의 독특한 부작용. Pulmonary HTN 인 경우 약제를 영구중단해야 한다. * Nilotinib : Metabolic event 들을 잘 생기게 한다. [sondoctor.co.kr]

  Among adult patients, 15–20% may suffer from mild joint pains. 16 Arthralgia was probably the most debilitating toxicity in our patients, forcing therapy alterations. [haematologica.org]

  (5.83%) 6 Metabolism and nutrition disorders Anorexia 12/103 (11.65%) 12 Decreased appetite 6/103 (5.83%) 6 Hyperglycaemia 6/103 (5.83%) 8 Hyperuricaemia 10/103 (9.71%) 20 Hypokalaemia 6/103 (5.83%) 7 Musculoskeletal and connective tissue disorders Arthralgia [clinicaltrials.gov]

• Headache

  Abstract We report a case of a 32-year-old lady with chronic myeloid leukemia (CML) on Imatinib for the past four years and in complete clinical, hematological and molecular remission who presented to us with sudden onset of headache, vomiting and diplopia [ncbi.nlm.nih.gov]

  Headaches and Other Neurological Symptoms Headaches and other neurologic symptoms such as seizures, dizziness, visual changes, nausea, and vomiting may occur when leukemia cells invade the fluid surrounding the brain and spinal cord (cerebrospinal fluid [verywellhealth.com]

  Read Andy’s victory against chronic myeloid leukaemia (CML): In the summer of 2003, Andy was feeling tired and getting frequent headaches then started to experience problems with his vision. [childrenwithcancer.org.uk]

  Other common side effects include nausea and vomiting, diarrhea, muscle cramps or muscle/joint pains, puffy eyes, headache, and skin rash. These are often short-lived and can be managed by briefly stopping or lowering the dose of a TKI. [cancersupportcommunity.org]

• Irritability

  It may first appear as anemia, with the patient finding colds and other minor irritations difficult to control. A complete blood count can rule out other disorders and indicate a need to conduct additional tests to confirm the CML diagnosis. [nationalcmlsociety.org]

  Fecal transplant is used to treat gut infections and is now being studied as a treatment for obesity, urinary tract infections, irritable bowel syndrome and more. [nytimes.com]

  GLEEVEC is sometimes associated with stomach or intestinal irritation. GLEEVEC should be taken with food and a large glass of water to minimize this problem. [us.gleevec.com]

  The most common side effects include thrombocytopenia, anemia, neutropenia, diarrhea, nausea, fatigue, weakness, skin irritation where the drug was given, fever, and infection. Learn more about the basics of chemotherapy. [cancer.net]

The diagnosis of chronic myeloid leukemia is based on the following [2]:

• Histologic findings in the peripheral blood
• Philadelphia (Ph) chromosome in bone marrow cells [4]

The workup for chronic myeloid leukemia should include the following [2]:

Complete blood count with differential

• Total white blood cell count - 20,000-60,000 cells/μL
• Increased basophils and eosinophils
• Mild to moderate anemia

Peripheral blood smear [2]

• Leukocyte alkaline phosphatase - absent in most cells
• Immature myeloid cells
• Leukoerythroblastosis, with circulating immature cells

Bone marrow analysis [2] [4]

• Philadelphia chromosome present - transposition of chromosomal material between chromosomes 9 and 22
• Elevated cell counts of neutrophils, eosinophils, and basophils
• Megakaryocytes are prominent and may be increased
• Mild reticulin fibrosis

• Philadelphia Chromosome Positive

  We report a case of a 72-year-old woman diagnosed with blastic phase of Philadelphia chromosome positive CML treated with IM for 28 months. The patient presented first with ascites as a side effect of the drug. [ncbi.nlm.nih.gov]

  and Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ALL). [doi.org]

• Thrombocytosis

  Three of 4 TKI-treated patients did not reach complete hematologic response due to the persistence of thrombocytosis and/or splenomegaly. [ncbi.nlm.nih.gov]

• Neutrophilia

  A 10-year-old boy presented with spontaneous bruising and was found to have extreme thrombocytosis without neutrophilia/shift to immaturity, basophilia or eosinophilia. [ncbi.nlm.nih.gov]

  Neutrophilia (a left-shifted WBC differential), basophilia, and eosinophilia are common. The platelet count is normal or moderately increased. The Hb level is usually > 10 g/dL. [merckmanuals.com]

  Neutrophilia (a left-shifted white blood cell differential), basophilia, and eosinophilia are common. The platelet count is normal or moderately increased, and in some patients, thrombocytosis is the presenting manifestation. [msdmanuals.com]

• Karyotype Abnormal

  The Philadelphia chromosome, which is a diagnostic karyotypic abnormality for chronic myelogenous leukemia, is shown in this picture of the banded chromosomes 9 and 22. [emedicine.medscape.com]

• Hyperuricemia

  Because of the increased turnover of myeloid cells, hyperuricemia may be present, and for this reason allopurinol is also indicated. [clinicaladvisor.com]

  The rapid killing of leukemic cells releases the intracellular contents into the blood circulation which causes hyperuricemia, hyperkalemia, hyperphosphatemia and may lead to fatal acute renal injury. [lecturio.com]

  Hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia in the context of acute kidney injury give concern for spontaneous TLS. [cancertherapyadvisor.com]

• Hypercellular Bone Marrow

  […] count of 147K and platelet count of 740K Promyelocyte, myelocytes, neutrophils and 2 basophils Chronic phase - bone marrow biopsy: Hypercellular marrow with panmyeloid hyperplasia Hypercellular marrow with increased megakaryocytes; myeloid cells are [pathologyoutlines.com]

  Because of such abnormal shapes, these cells are destroyed before releasing into the peripheral blood circulation, leading to cytopenias and hypercellular bone marrow. [lecturio.com]

• Leukocytosis

  Her disease was managed during pregnancy using interferon-α alone despite persistent leukocytosis. CML may be effectively managed during pregnancy, even in the setting of leukocytosis, without the application of leukocytapheresis. [ncbi.nlm.nih.gov]

  It presents with neutrophilic leukocytosis. It can appear at any age, but it mostly affects middle aged and older individuals. Patients usually present with fatigue, weight loss, anemia, night sweats, and splenomegaly. [icd9data.com]

  Clinical Findings · Most pts are asymptomatic at diagnosis, leukocytosis is found incidentally · Can develop fatigue, night sweats, weight loss and splenomegaly on exam · The peripheral smear typically demonstrates a leukocytosis with a median white count [errolozdalga.com]

The goals of treatment of chronic myeloid leukemia are to achieve hematologic, cytogenetic, and molecular remission. Although a variety of medications have been used in chronic myeloid leukemia, including myelosuppressive agents and interferon alfa, the tyrosine kinase inhibitor, imatinib mesylate, is currently the drug of choice [7].

Other drugs in this category are increasingly used [8]. Some patients with molecular remissions from interferon alfa and imatinib may be cured, but this can only be established over time [3] [5] [9].

Allogeneic bone marrow transplantation is currently the only proven cure for chronic myeloid leukemia [8]. Bone marrow or stem cell transplantation are investigative therapies at present used only for younger patients and are extremely expensive.
New agents that are currently under research may prolong the survival of patients with chronic myeloid leukemia and may even offer the possibility of eventual cure [8] [9].

In October 2012, the US Food and Drug Administration (FDA) approved omacetaxine (Synribo). Omacetaxine is a protein translation inhibitor that is indicated in the accelerated phase of patients with chronic myeloid leukemia resistant to or intolerant to 2 or more tyrosine kinase inhibitors [10].

Leukapheresis, using a cell separator, can lower white blood cell counts rapidly and safely. It is used in patients with white blood cell counts greater than 300,000 cells/µ and can alleviate acute symptoms [8].

Splenectomy and splenic irradiation have been used in patients with large and painful spleens, usually in the later phases of chronic myeloid leukemia [8]. Splenectomy is associated with a high incidence of post-operative complications, morbidity, and mortality.

In the past, patients with chronic myeloid leukemia had a median survival rate of 3-5 years from the time of diagnosis. New therapeutic agents have resulted in improvement in survival.

Currently, patients have a median survival of 5 or more years, 50-60% of patients survive at least 5 years. The improvement has resulted from earlier diagnosis, improved therapy with interferon, bone marrow transplantation, and better supportive care [5].

Some patients with remissions from interferon alfa, may be cured, but this can only be proven over time [5] [6].

Chronic myeloid leukemia is caused by a single, specific genetic mutation. More than 90% of cases result from a mutation of a gene responsible for cell production known as the Philadelphia chromosome [3].

Causes for the mutation are not fully known, though exposure to radiation and toxic chemicals is strongly suspected.

Chronic myeloid leukemia accounts for 20% of all leukemias affecting adults [2]. It usually affects the middle-aged, uncommonly, occurring in younger individuals.

Younger patients may have a more aggressive form of chronic myeloid leukemia, presenting in the accelerated phase or in blast crisis.

Chronic myeloid leukemia is an acquired abnormality that involves the hematopoietic stem cells. It is characterized by an abnormality that causes a reciprocal translocation of the long arms of chromosomes 22 and 9 [1] [3].

The translocation results in a shortened chromosome 22, first noted by Nowell and Hungerford in Philadelphia and named the Philadelphia (Ph1) chromosome after the city where it was discovered [2] [3].

The resulting gene forms a mutant protein with strong tyrosine kinase activity. The manifestation of this protein causes the development of chronic myeloid leukemia through processes that are not yet fully understood [2] [3] [4].

The cause of chronic myeloid leukemia is still unknown, but exposure to ionizing radiation is suspected. It was observed among survivors of the atomic bombing of Hiroshima and Nagasaki. Other agents, such as benzene, are also possible causes [2].

There are no guidelines for prevention of chronic myeloid leukemia.

Chronic myeloid leukemia is a bone marrow stem cell disorder characterized by increased production of the granulocytic white blood cells and decreased hematopoiesis leading to cytopenia.

Chronic myeloid leukemia progresses through 3 phases: chronic, accelerated, and blastic. In the chronic phase of the disease most white blood cells are mature. In the accelerated phase additional cell abnormalities occur. In the blast phase immature cells proliferate rapidly, crowding out normal cells.

Prolonging survival is the primary goal of therapy. Allogeneic stem cell transplantation (SCT) remains the only curative treatment, but is rarely used in elderly patients [1] [2].

What is chronic myeloid leukemia?

Chronic myeloid leukemia is a slowly progressing form of blood cancer. It interferes with the production of blood cells in the bone marrow, where blood cells are made. As a result your body makes too many abnormal, immature white blood cells, called blast cells. Healthy white blood cells help to fight infection. The abnormal cells can no longer perform this function.

In chronic myeloid leukemia the bone marrow makes a greatly increased numbers of abnormal blast cells. These immature cells live longer than normal cells. They crowd out healthy white blood cells, and also red blood cells and platelets (responsible for clotting) as well.

What are the symptoms of chronic myeloid leukemia?

Chronic myeloid leukemia has three phases: chronic, accelerated, and blastic. Chronic-phase chronic myeloid leukemia is the earliest phase and the easiest to treat. The individual may have no symptoms at all.
In the accelerated phase, the number of abnormal blood cells increases. Some or all of these symptoms may be present:

• Fatigue
• Fever
• Bruising
• Night sweats
• Shortness of breath
• Unexplained weight loss
• Appetite loss
• Swelling or pain on your left side (which could be a sign of an enlarged spleen)
• Bone pain

What causes chronic myeloid leukemia?

The exact cause of chronic myeloid leukemia is not known. It starts when a new chromosome, called the Philadelphia chromosome, is formed by the switching of the DNA between two chromosomes (9 and 22).

This new gene tells blood cells to make a new protein which causes the body to begin making too many abnormal, or immature, white blood cells, leaving less room for healthy blood cells and platelets.

Who gets chronic myeloid leukemia?

Anyone can get chronic myeloid leukemia; however, it usually affects middle-aged or older adults. It rarely occurs n children. It happens more frequently in men and those exposed to radiation and certain chemicals.

Family history is not a risk factor. The chromosome mutation that leads to chronic myelogenous leukemia is not passed from parents to their children. This mutation is believed to be acquired, meaning it occurs after birth.

How is chronic myeloid leukemia diagnosed?

Chronic myeloid leukemia is diagnosed using blood tests that show the type and number of the various blood cells, especially white blood cells. Diagnosis is confirmed by biopsy (sampling) of the bone marrow when the presents of a mutated chromosome, called the Philadelphia chromosome, is found.

How is chronic myeloid leukemia treated?

Once a diagnosis of chronic myeloid leukemia is made the goal of treatment is to prevent the progression of the disease as long as possible. Best treatment should include a referral to and evaluation by a doctor with special training in blood diseases/cancers (hematologist-oncologist).

The goal is to stay in the chronic phase and remain symptom-free.
Chronic myelogenous leukemia is a disease that most patients will continue treatment for the rest of their lives.

Treatment of chronic myeloid leukemia is aimed at destroying the abnormal blood cells and restoring normal white blood cells to normal levels.

Diagnosis and treatment beginning in the early, chronic phase of the disease can slow and even prevent the disease from moving to a more serious level.

Medications known as tyrosine kinase inhibitors are usually the first form of treatment. They slow down the production of abnormal white cells.

Other treatment options include chemotherapy, to destroy the abnormal white blood cells, and with interferon which decreases the production of white blood cells. A stem cell transplant from a matching donor may be curative but it is difficult to obtain a match and the procedure is very expensive. It is usually used only when other treatments have failed.

What are the complications of chronic myeloid leukemia?

Complications of chronic of chronic myeloid leukemia may include the following:

• Fatigue due to anemia (decreased number of red blood cells).
• Excessive bleeding and bruising because the number of platelets (blood cells that help control clotting) is decreased.
• Bone pain or joint pain because of expansion of the bone marrow from the buildup of white blood cells.
• Swollen or enlarged spleen due to the e storage of the extra blood cells in the spleen.
• Infection is a significant risk because abnormal white blood cells are not able to fight off infection.
• Death will occur if chronic myeloid leukemia cannot be successfully treated.

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