chronic myelogenous leukemia

1. CHRONIC MYELOGENOUS
LEUKEMIA(CML)
DR. SOMA THAKUR
M.D.(PATHOLOGY)

2. Definition
• A myeloproliferative neoplasm arising from abnormal pleuripotent
stem cell & associated with BCR-ABL fusion gene located in
Philadelphia chromosome,leading to uncontrolled proliferation of
granulocytes.

3. Epidemiology
• Incidnce -1-2 cases/100,000 population.
• Any age,more common- 50-60 yrs.
• Male>female
• Etiology-unknown,radiation exposure etc.
• Clinical feature -
Insiduous onset
Asymptomatic
Symptoms-fatigue,wt. loss,night sweats
hepatosplenomegaly,lymphadenopathy & anaemia.

4. 1.CHRONIC PHASE
• Lasts for 3-4 years
• General examination-splenomegaly
• Cbc- leucocytosis with predominance of segmented neutrophils &
myelocytes,thrombocytosis usually.
• Pbs-2% blasts,basophilia,eosinophilia,monocytosis<3%
• Bone marrow- hypercellular with marked granulocytic proliferation with
significantly increased myelocytes
increased M:E ratio
megakaryocytes-variable.
Small ,hypolobate called as dwarf megakaryocyte is characteristic.
Bone marrow biopsy- increase in thickness of immature granulocyte along
bone trabeculae.

5. ACCELERATED PHASE
• Any one of following criteria:-
1.persistent/increasing wbc
2.persistent thrombocytosis unctrolled by therapy
3.persistent thrombocytopenia unrelated to therapy
4. clonal cytogenetic evolution occurring after initial diagnostic
karyotype
5.20% or more basophils in peripheral blood
6. 10-19% myeloblasts in blood or bone marrow.

6. BLAST PHASE
• Blasts>=20% of pb wbc or nucleated cells of bone marrow
or
• Extramedullary blasts proliferations(skin,ln,spleen,bone,cns etc.)

7. Diagnosis
• Philadelphia chromosome or BCR-ABL
• If no Philadelphia chromosome – FISH –to detect cryptic
transformation of BCR-ABL .

8. Differential diagnosis
• Infections
• Drugs
• Other myeloproliferative neoplasms like CNL & PV

9. THANK
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