Revision 3 for 'Chronic myeloid leukemia'

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Chronic myeloid leukemia

Chronic myeloid leukemia, also known as chronic myelogenous leukemia, is a myeloproliferative neoplasm characterized by the overproduction of granulocytes with fairly normal differentiation.

Epidemiology

The annual incidence is about 1 per 100,000 1. The typical age at presentation is 50-60 years 1.

Clinical presentation

Constitutional symptoms are common, such as fatigue, weight loss, and sweats 2. Some patients are asymptomatic, with the diagnosis being first suspected based upon routine blood work finding leukocytosis with a predominance of the neutrophil lineage.

Pathology

Genetics

Chronic myeloid leukemia is caused by a chromosomal abnormality in hematopoietic stem cells in which reciprocal translocation between chromosomes 9 and 22 creates the fusion gene BCR-ABL1. The shortened chromosome 22 containing the fusion gene is called the Philadelphia chromosome. The diagnosis is established by karyotype (to detect the Philadelphia chromosome), fluorescence in situ hybridization (to detect the BCR-ABL1 fusion gene), or reverse transcription polymerase chain reaction (to detect the BCR-ABL1 mRNA product).

Radiographic features

Patients commonly have splenomegaly and diffuse marrow infiltration (manifest as abnormally low signal on T1-weighted MRI).

Treatment and prognosis

First-line medical therapy consists of tyrosine kinase inhibitors (imatinib, dasatinib, or nilotinib) 1. With tyrosine kinase inhibitor treatment, life expectancy approaches that of the general population. In some treated patients and in untreated patients, the disease progresses over several years through an accelerated phase and culminates in a blast phase (or blast crisis), which represents a fatal acute leukemia.

See also

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