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| *Ph-, mostly BCR- | | *Ph-, mostly BCR- |
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| CML is often divided into three phases based on clinical characteristics and laboratory findings. In the absence of intervention, CML typically begins in the ''chronic'' phase, and over the course of several years progresses to an ''accelerated'' phase and ultimately to a ''blast crisis''. Blast crisis is the terminal phase of CML and clinically behaves like an [[acute leukemia]]. One of the drivers of the progression from chronic phase through acceleration and blast crisis is the acquisition of new chromosomal abnormalities (in addition to the Philadelphia chromosome). Some patients may already be in the accelerated phase or blast crisis by the time they are diagnosed.
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| ===Chronic phase===
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| Approximately 85% of patients with CML are in the chronic phase at the time of diagnosis. During this phase, patients are usually asymptomatic or have only mild symptoms of fatigue or abdominal fullness. The duration of chronic phase is variable and depends on how early the disease was diagnosed as well as the therapies used. Ultimately, in the absence of curative treatment, the disease progresses to an accelerated phase.
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| ===Accelerated phase===
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| Criteria for diagnosing transition into the accelerated phase are somewhat variable; the most widely used criteria are those put forward by investigators at M.D. Anderson Cancer Center,<ref>{{cite journal | author = Kantarjian H, Dixon D, Keating M, Talpaz M, Walters R, McCredie K, Freireich E | title = Characteristics of accelerated disease in chronic myelogenous leukemia. | journal = Cancer | volume = 61 | issue = 7 | pages = 1441-6 | year = 1988 |pmid=3162181}}</ref> by Sokal et al,<ref>{{cite journal | author = Sokal J, Baccarani M, Russo D, Tura S | title = Staging and prognosis in chronic myelogenous leukemia. | journal = Semin Hematol | volume = 25 | issue = 1 | pages = 49-61 | year = 1988 | id = PMID 3279515}}</ref> and the [[World Health Organization]].<ref>{{cite journal | author = Vardiman J, Harris N, Brunning R | title = The World Health Organization (WHO) classification of the myeloid neoplasms. | journal = Blood | volume = 100 | issue = 7 | pages = 2292-302 | year = 2002 |pmid=12239137|url=http://www.bloodjournal.org/cgi/content/full/100/7/2292|accessdate=2007-09-22}}</ref> The WHO criteria are perhaps most widely used, and include:
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| *10–19% [[myeloblast]]s in the blood or [[bone marrow]]
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| *>20% [[basophil]]s in the blood or bone marrow
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| *[[Platelet]] count <100,000, unrelated to therapy
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| *Platelet count >1,000,000, unresponsive to therapy
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| *Cytogenetic evolution with new abnormalities in addition to the Philadelphia chromosome
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| *Increasing [[splenomegaly]] or white blood cell count, unresponsive to therapy
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| The patient is considered to be in the accelerated phase if any of the above are present. The accelerated phase is significant because it signals that the disease is progressing and transformation to blast crisis is imminent.
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| ===Blast crisis===
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| Blast crisis is the final phase in the evolution of CML, and behaves like an [[acute leukemia]], with rapid progression and short survival. Blast crisis is diagnosed if any of the following are present in a patient with CML:<ref>{{cite journal|title=Blastic phase of chronic myelogenous leukemia|author=Karbasian Esfahani M, Morris EL, Dutcher JP, Wiernik PH|date=2006|journal=Current Treatment Options in Oncology|volume=7|issue=3|pages=189-199|pmid= 16615875}}</ref>
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| *>20% [[myeloblast]]s or [[lymphoblast]]s in the blood or bone marrow
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| *Large clusters of blasts in the bone marrow on [[bone marrow biopsy|biopsy]]
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| *Development of a [[chloroma]] (solid focus of leukemia outside the bone marrow)
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| ==References== | | ==References== |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]
Overview
Chronic myelogenous leukemia may be classified according to the hematologic characteristics and laboratory findings into five subtypes: chronic granulocytic leukaemia (CGL), juvenile CML, chronic neutrophilic leukaemia (CNL), chronic myelomonocytic leukaemia (CMML) ,and atypical chronic myelogenous leukemia (aCML).[1]
Classification
Chronic myelogenous leukemia is often divided into five subtypes.
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Associations
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Chronic granulocytic leukaemia (CGL)
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- 95% of all CML
- 90% are Ph+, BCR+
- 5% are Ph-, BCR+
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Juvenile chronic myelogenous leukemia
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Chronic neutrophilic leukaemia (CNL)
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Chronic myelomonocytic leukaemia (CMML)
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Atypical chronic myelogenous leukemia (aCML)
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References
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