Chronic myeloid leukemia

Chronic myeloid leukemia - Acute
Rahul Soman, M. Pharm

 

Definition  

A clonal myeloproliferative disorder resulting in the overproduction and over-proliferation of Philadelphia chromosome-positive myeloid cells

 

Suspected and known chronic myeloid leukemia  

* Chromosome analysis, cytogenetic procedure AND/OR molecular biology method, Bone marrow specimen: Cytogenic analysis usually detects the Ph1; molecular analysis detects BCR-ABL translocation and transcripts; both methods assess response to therapy .

 

Allogeneic Hematopoietic Stem Cell Transplant Recipients  

 

Monitoring following allogeneic hematopoietic stem cell transplantation  

* Polymerase chain reaction analysis, Peripheral blood

 

Management Goals  

 

Monitoring following tyrosine kinase inhibitor therapy  

* Polymerase chain reaction analysis, Peripheral blood

* Gene mutation analysis

 

Suspected and known chronic myeloid leukemia  

* Chromosome analysis, cytogenetic procedure AND/OR molecular biology method, Bone marrow specimen: Cytogenic analysis usually detects the Ph1; molecular analysis detects BCR-ABL translocation and transcripts; both methods assess response to therapy .

 

Medical History  

* Past medical history of Radiation injury

 

Findings  

* Splenomegaly

* Night sweats

* Bleeding

* Bone pain

* Fatigue

* Fever

* Hepatomegaly - Acute

* Abnormal weight loss

* Lymphadenopathy - Acute

* Pallor

* Pleural effusion - Acute

 

Tests  

 

Suspected and known chronic myeloid leukemia  

* Complete blood count with white cell differential, manual: Neutrophilic leukocytosis and basophilia are hallmark features of chronic phase CML. Worsening cytoses are associated with progressing disease .

* Bone marrow examination: Marrow hypercellularity, basophilia, and the presence of blasts cells are hallmark findings of CML .

* Chromosome analysis, cytogenetic procedure AND/OR molecular biology method, Bone marrow specimen: Cytogenic analysis usually detects the Ph1; molecular analysis detects BCR-ABL translocation and transcripts; both methods assess response to therapy .

 

Initial evaluation of chronic myeloid leukemia  

* Electrolytes measurement, serum

* Basic metabolic panel

 

Suspected and known chronic myeloid leukemia  

* White blood cell cytochemistry: Chronic phase neutrophils have reduced expression of alkaline phosphatase. Immunophenotypic analysis distinguishes myeloid vs lymphoid blast phase .

 

Evaluation of potential candidates for hematopoietic stem cell transplantation  

* HLA antigen typing

 

Differential Diagnosis  

* Chronic phase chronic myeloid leukemia

* Neutrophilic leukemoid reaction

* Chronic myelomonocytic leukemia

* Atypical chronic myeloid leukemia

* Myeloproliferative disorder - Chronic

* Polycythemia vera

* Primary thrombocytopenia

* Chronic neutrophilic leukemia

* Chronic eosinophilic leukemia

* Accelerated phase chronic myeloid leukemia

* Blastic phase chronic myeloid leukemia

* Acute myeloid leukemia - Acute

* Acute lymphoid leukemia - Acute

 

Treatment  

 

Drug Therapy  

 

Chronic myeloid leukemia  

 

IMATINIB MESYLATE  

 

 

PEGINTERFERON ALFA-2B  

 

CYTARABINE

 

Chronic myeloid leukemia with WBC count >20,000/mm3  

 

ALLOPURINOL  

 

HYDROXYUREA

 

 

Procedural Therapy  

 

Chronic myeloid leukemia  

* Hemopoietic stem cell transplant: Allogeneic HSCT is the only known treatment for CML with curative potential ; however, the success of tyrosine kinase inhibitor therapy has altered the use of HSCT .

 

Relapse of chronic myeloid leukemia following hematopoietic stem cell transplantation  

* Donor lymphocyte infusion