Chronic Myeloid Leukemia

1. CHRONIC MYELOID
LEUKAEMIA
Jihad al- Gadeeb
Medicle Intern

2. CML
• Chronic myelogenous leukemia (CML), also
known as chronic myeloid leukemia, is a
myeloproliferative disorder characterized by
increased proliferation of the granulocytic cell
line. Consequently, the peripheral blood cell
profile shows an increased number of
granulocytes and their immature precursors,
including occasional blast cells.

3. INCIDENCE
• 15% of leukaemias.
• It occurs most often between 40–
60yrs
• slight male predominance

4. Phladiphia chromosome
• Present in >80% of those with CML. It is a
hybrid chromosome comprising reciprocal
translocation between the long arm of
chromosome 9 and the long arm of
chromosome 22—t(9;22) forming a fusion
gene BCR/ABL on chromosome 22, which
has tyrosine kinase activity

6. causes
• The initiating factor of CML is still unknown,
but exposure to ionizing radiation
• increased prevalence among survivors of the
atomic bombing of Hiroshima and Nagasaki.
• Radiotherapy for a cancer in the past
• benzene

7. CML progresses through 3 phases
• Chronic phase
• Accelerated phase
• Blast phase.

8. Chronic phase
• Mature cells proliferat
• its response to the treatment and easilly
controlled

9. The accelerated phase
• Additional cytogenetic abnormalities occur
• Diesease controle becomes more difficult

10. The blast phase
• in the blast phase, immature cells rapidly
proliferat
• The disease transform from chronic to acut
leukemia which relitivelly not response to the
treatment
•

12. • Approximately 85% of patients are
diagnosed in the chronic phase and then
progress to the accelerated and blast phases
after 3-5 years.

13. • The diagnosis of CML is based on the
histopathologic findings in the peripheral
blood and the Philadelphia chromosome in
bone marrow cells

16. Clinical picture
• Clinical picture
• Low-grade fever
• excessive sweating hypermetabolism.
• fatigue
• weight loss
• Loss of energy
• decreased exercise tolerance
• Left upper quadrant abdominal pain described as
"gripping"

17. • In some patients who present in the
accelerated, or acute, leukemia phase of the
disease (skipping the chronic phase), bleeding,
petechiae, and ecchymoses may be the
prominent symptoms

18. • Bone pain and fever, as well as an increase in
bone marrow fibrosis
• may be features of gout

19. • Investigation
• CBC with differential
• peripheral blood smear
• bone marrow analysis
• US using for liver/spleen

20. • WBC ↑↑ (often >100 × 109/L) with whole
spectrum of myeloid cells ie
↑neutrophils, myelocytes, basophils, eosinop
hils.
• Hb↓ or normal,
• platelets variable.
• Urate↑,
• B12↑

22. • Bone marrow is hypercellular. Ph found on
cytogenetic analysis of blood or bone marrow

23. Treatment
• Chronic phase:
• Hydroxyurea or interferon-α, with allopurinol
• Specific treatment:
• Imatinib and Dasatinib (tyrosine kinase inhibitors) act
as inhibitors ofBCR-ABL.
• Stem cell transplantation
• :Allogeneic or autogenous.

24. • Hydroxyurea
• may still be used in patients intolerant of
imatinib
• Dasatinib
• may have a role in imatinib-resistant blast
crises.

25. • Hydroxyurea
• may still be used in patients intolerant of
imatinib
• Dasatinib
• may have a role in imatinib-resistant blast
crises.