Chronic myeloid leukemia

Background

• Also known as chronic myelogenous leukemia, chronic myelocytic leukemia
• More common in older patients

Clinical Features

Usually progresses through 3 stages

Chronic phase

• Asymptomatic or indolent, nonspecific symptoms
• Malaise, fatigue, weight loss, low grade fever
• Lymphadenopathy, splenomegaly

Accelerated phase

• Worsening of above symptoms due to progressive leukocytosis
• Signs/symptoms of thrombocytopenia (e.g. petechiae, bleeding) or thrombocytosis

Blast crisis

• Behaves like acute leukemia
• Associated with Leukostasis and hyperleukocytosis and Hyperviscosity syndrome

Differential Diagnosis

Oncologic Emergencies

Related to Local Tumor Effects

• Malignant airway obstruction
• Bone metastases and pathologic fractures
• Malignant spinal cord compression
• Malignant Pericardial Effusion and Tamponade
• Superior vena cava syndrome

Related to Biochemical Derangement

• Hypercalcemia of malignancy
• Hyponatremia due to SIADH
• Adrenal insufficiency
• Tumor lysis syndrome
• Carcinoid syndrome

Related to Hematologic Derangement

• Neutropenic fever
  • Neutropenic enterocolitis (typhlitis)
• Leukostasis and hyperleukocytosis
• Hyperviscosity syndrome
• Thromboembolism

Related to Therapy

• Chemotherapy-induced nausea and vomiting
• Chemotherapeutic drug extravasation
• Differentiation syndrome (retinoic acid syndrome) in APML
• Stem cell transplant complications

Leukocytosis

• Normally responding bone marrow
  • Infection
  • Inflammation: tissue necrosis, infarction, burns, arthritis
  • Stress: overexertion, seizures, anxiety, anesthesia
  • Drugs: corticosteroids, lithium, beta agonists
  • Trauma: splenectomy
  • Hemolytic anemia
  • Leukemoid malignancy
• Abnormal bone marrow
  • Acute leukemia
    • Acute myeloid leukemia
    • Acute lymphocytic leukemia
  • Chronic leukemia
    • Chronic myeloid leukemia
  • Myeloproliferative disorders

Evaluation

• CBC
  • Leukocytosis: usually only moderately elevated in chronic phase (20,000-60,000)
  • Mild-moderate anemia
  • Variable platelet counts
• Peripheral smear
• DIC labs: coags, d-dimer, fibrinogen
• Tumor lysis syndrome labs: BMP, uric acid, phosphate
• Infectious workup
• Evaluate for complications

Management

• See management of Leukostasis and hyperleukocytosis, neutropenic fever, hyperviscosity syndrome, DIC, tumor lysis syndrome, thrombocytopenia, anemia

See Also

• Oncologic emergencies
• Leukostasis and hyperleukocytosis
• Acute leukemia

References

Authors

Claire, Ross Donaldson