Chronic Myeloid Leukemia (CML): Symptoms, Diagnosis, and Treatment

Chronic Myeloid Leukemia (CML): Symptoms, Diagnosis, and Treatment

Question. Write a short note on chronic myeloid leukemia.

Answer. Chronic myeloid leukemia is a clonal disorder of a pluripotent stem cell.

The most important characteristic feature of chronic myeloid leukemia is the demonstration of the Philadelphia chromosome in leukemic blast cells.

Clinical Features Of Chronic Myeloid Leukemia:-

Common Features Of Chronic Myeloid Leukemia:-

• Nonspecific: Loss of weight, fatigue, malaise, excessive perspiration.
• Splenomegaly: The Size of the spleen is enlarged
• Bleeding, excessive menstrual or other bleeding.
• Anemia
• Bone pain: It is due to the extension of hemopoiesis through long bones.

Chronic Myeloid Leukemia (CML): Symptoms, Diagnosis, and Treatment

Rare Features Of Chronic Myeloid Leukemia:-

• Splenic infarction
• Leukostasis
• Gout
• Retinal hemorrhage
• Fever.

Etiology Of Chronic Myeloid Leukemia:-

Chronic myeloid leukemia results from translocation of genetic material between chromosome 9 and 22.

The translocation result in production of abnormal tyrosine kinase that makes affcted cell immortal.

Investigations Of Chronic Myeloid Leukemia:-

• Peripheral blood: WBC count is 10–500 × 10 9/L, with excess of neutrophils, myelocytes and blasts. Basophilia and eosinophilia are prominent and thrombocytosis is common.
• Bone marrow is hypercellular with marrow firosis and gaucher like cells. High myeloid to erythroid ratio, i.e. 15 to 20 : 1.
• Neutrophil alkaline phosphatase is low.
• Serum vitamin B12 is increased.
• Serum uric acid is increased.

Hereditary Blood Disorders

Treatment Of Chronic Myeloid Leukemia:-

Chronic Phase Of Chronic Myeloid Leukemia:-

• Tyrosine kinase inhibitor therapy with Imatinib 400 mg OD as fist line.
• Othersecond generation: Tyrosine kinase inhibitor advocated in fist line therapy.
• Ponatinib used in case of resistant to fist and second generation Tyrosine kinase inhibitor.
• Zinatinib is now used in cases of very high counts.
• Allogenic stem cell transplant with HLA­atched­related or unrelated donor, in case of Tyrosine kinase inhibitor intolerance
• Omacetaxine can also be given.
• Alpha­interferon therapy can be given to maintain remission in chronic phase of disease in patient less than 70 years of age. It is given either intramuscularly or subcutaneously in dose of 3 to 9 mega units daily, then dose is reduced and majority of patients tolerate the dose of 3 mega units/3 times a week without any side effct.

Symptoms of Chronic Myeloid Leukemia (CML)

Advanced Phase Disease Of Chronic Myeloid Leukemia:-

• Treatment oflymphoid blast crisis is done: Treatment similar to Acute lymphoblastic leukemia is done.
• Myeloid crisis: Prognosis is poor and few of drugs used in treatment of AML offr more than temporary relief.