Chronic myelogenous leukemia diagnostic study of choice: Difference between revisions

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* Bone marrow biopsy  
* Bone marrow biopsy  


=== Name of Diagnostic Criteria ===
=== Name of Diagnostic Criteria:  ===
WHO criteria of diagnosing different phases of chronic myeloid leukemia is following: <ref name="pmid">{{cite journal |vauthors= |title= |journal= |volume= |issue= |pages= |date= |pmid= |doi= |url=}}</ref>


'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
{| class="sortable mw-collapsible mw-collapsed"
|+'''WHO Criteria of diagnosing different phases of CML'''
!CML chronic phase                         
!CML  accelerated phase                                       
!CML blast phase                               
|-
|Granulocytosis in the presence of
ph chromosome and/or BCR/ABL
|Increasing spleen size and WBC unresponsive to therapy
|Blasts ≥ 20% in perpheral blood and bone marrow
|-
|NO sign of CML accelerated phase
|Cytogenetic evidence of clonal evolution of  
Blasts 10–19% in peripheral blood and/or bone marrow
|Extramedullary blast proliferation
|-
|
|Peripheral blood basophils ≥ 20%
|Large foci or clusters of blasts in the bone marrow biopsy
|-
|
|Persistent thrombocytopenia (< 100 x 109/L)


[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
unrelated to therapy or


OR
Persistent thrombocytosis (> 1000 x 109/L)


There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
unresponsive to therapy
 
|
OR
|}
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
 
OR
 
'''IF there are clear, established diagnostic criteria'''
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
'''IF there are no established diagnostic criteria'''
 
There are no established criteria for the diagnosis of [disease name].


==References==
==References==

Revision as of 19:27, 26 October 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Badria Munir M.B.B.S.[2]

Overview

Diagnostic Study of Choice

Study of choice

  • Chronic myelogenous leukemia is primarily diagnosed based on the clinical presentation, supported by the typical findings in the blood and bone marrow, and then confirmed by the determination of one of the following
    • the Philadelphia chromosome
    • the BCR-ABL1 fusion gene
    • the BCR-ABL1 fusion mRNA
  • Using one of the folowing techniques:
    • Conventional cytogenetics
    • Fluorescence in situ hybridization (FISH) analysis
    • Reverse transcription polymerase chain reaction (RT-PCR)
Diagnostic results

The following finding(s) on performing PCR is confirmatory for [chronic myelogenous leukemia]].

    • the Philadelphia chromosome
    • the BCR-ABL1 fusion gene
    • the BCR-ABL1 fusion mRNA
Sequence of Diagnostic Studies

The peripheral blood studies must be performed when:

  • The patient presented with signs of anemia, lecopenia and thrombocytopenia as the first step of diagnosis.

Peripheral blood studies may show :

Characteristic complete blood count (CBC) features are as follows:[1]

  • Absolute leukocytosis (median of 100,000/µL) with a left shift and classic “myelocyte bulge” (more myelocytes than the more mature metamyelocytes seen on the blood smear)
  • blasts usually number <2%;
  • Absolute basophilia, in 90% of cases
  • Monocytosis is often seen, but generally not an increased monocyte percentage
  • Absolute monocytosis is more prominent in the unusual cases with a p190 BCR-ABL
  • Platelet count is usually normal or elevated;
  • Thrombocytopenia suggests an alternative diagnosis or the presence of advanced stage, rather than chronic phase, disease.

The various investigations must be performed in the following order:

  • Peripheral blood studies
  • Bone marrow biopsy

Name of Diagnostic Criteria:

WHO criteria of diagnosing different phases of chronic myeloid leukemia is following: [2]

WHO Criteria of diagnosing different phases of CML
CML chronic phase CML accelerated phase CML blast phase
Granulocytosis in the presence of

ph chromosome and/or BCR/ABL

Increasing spleen size and WBC unresponsive to therapy Blasts ≥ 20% in perpheral blood and bone marrow
NO sign of CML accelerated phase Cytogenetic evidence of clonal evolution of

Blasts 10–19% in peripheral blood and/or bone marrow

Extramedullary blast proliferation
Peripheral blood basophils ≥ 20% Large foci or clusters of blasts in the bone marrow biopsy
Persistent thrombocytopenia (< 100 x 109/L)

unrelated to therapy or

Persistent thrombocytosis (> 1000 x 109/L)

unresponsive to therapy

References

  1. ↑ Melo JV, Myint H, Galton DA, Goldman JM (January 1994). "P190BCR-ABL chronic myeloid leukaemia: the missing link with chronic myelomonocytic leukaemia?". Leukemia. 8 (1): 208–11. PMID 8289491.
  2. ↑ Empty citation (help)

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