Chronic myeloid leukemia

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

• Leukemoid reaction
• Juvenile myelomonocytic leukemia
• Chronic myelomonocytic leukemia
• Chronic eosinophilic leukemia
• Chronic neutrophilic leukemia

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