Chronic myeloid leukemia

From IDWiki
(Redirected from CML)

Clinical Manifestations

  • Triphasic: chronic phase, accelerated phase, and blast crisis
  • Almost half are asymptomatic on diagnosis, found by abnormalities on routine bloodwork
  • Presenting complaints may include fatigue, weight loss, sweating, abdominal fullness, and bleeding
  • Often have splenomegaly, which can contribute to the abdominal fullness and cause LUQ or left shoulder pain
  • Can present with anemia, very elevated WBCs, and elevated platelets
  • Can precipitate gout
  • Extramedullary findings are usually limited to blast crisis, and would include lymphadenopathy, skin findings, and soft tissue findings

Prognosis and Complications

  • Outcomes are very good since the introduction of tyrosine kinase inhibitors
  • Prognostic models exist, including Sokal score, Euro (Hasford), EUTOS, and ELTS scores

Differential Diagnosis

Diagnosis

  • Usually suspected in asymptomatic patient with typical findings in peripheral blood or bone marrow
  • Confirmed with detection of BCR-ABL1 fusion gene in peripheral blood or bone marrow

Management

  • Can use empiric hydroxyurea for cytoreduction while awaiting diagnosis if WBC >80