This document discusses myeloproliferative diseases, specifically chronic myeloid leukemia (CML). It begins with an overview of the WHO classification of chronic myeloproliferative neoplasms. It then focuses on CML, covering its epidemiology, pathogenesis, clinical features including symptoms in chronic phase, and investigations such as karyotyping, FISH and peripheral smear and bone marrow findings. The document discusses prognosis in the pre-imatinib and imatinib eras. It outlines the evolution of treatment for CML, including FDA-approved tyrosine kinase inhibitors like imatinib, nilotinib, dasatinib and bosutinib.

1. Myeloproliferative Disease
 Dr Bhupedra Shah
 Assistant Professor
 Department of Internal Medicine
 B.P.Koirala Institute of Health Sciences

2. Cell Lineage

3. World Health Organisation classification of Chronic Myeloproliferative neoplasm
Chronic myeloid leukemia
Chronic neutrophilic leukemia
Chronic eosinophilic leukemia
Polycythemia vera
Primary myelofibrosis
Essential thrombocytosis
Mastocytosis
Myeloproliferative neoplasm unclassifiable

4. Chronic Myelogenous leukemia

5. Epidemiology of CML

6. Pathogenesis of CML

7. Pathogenesis of CML

8. Clinical features
 Chronic phase
 Accelerated phase
 Blast crisis

9. Symptoms of chronic phase of CML
ANEMIA Spleenomegaly PLATELET DYSFUNCTIONS

10. Lab investigation
 Haemoglobin---
 WBC---
 Basophil---
 Eosinophil
 Platelet
 Leucocyte alkaline phosphatase
 Sr. Uric acid—
 Lactate dehyrogenase

11. Chronic myeloid leukemia- Peripheral smear

12. Bone marrow finding of CML

13. Further investigation
KARYOTYPING FISH

14. Prognosis
Variables Median survival time
Pre-Imatinib era 5-7 years
Imatinib era 90% survive even after 10 years

15. Treatment EVOLUTION in CML

16. FDA approved TKI therapy
 Imatinib therapy(Gleevac)
 Nilotinib
 Dasatinib
 Bosutinib
 Ponatinib
 …..i M BOS NILO DAS PANDIT….

17. Imatinib mesyate
 Dose- 400mg/day

18. Thank you…