Chronic myelogenous leukemia natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]
Overview
If left untreated, majority of patients with chronic myelogenous leukemia may progress from a chronic phase where differentiation is reasonably well-maintained to blast or acute phase (BP) where differentiation is lost. the progression to BP occurs at a median of 3–5 years from diagnosis in untreated patients. some complications of chronic myelogenous leukemia include Fatigue, excess bleeding, enlarged spleen, and infection. Prognosis is generally poor, and the 5-year survival rate of patients with chronic myelogenous leukemia is approximately 59.9%.[1][2]targeted therapy with small molecule tyrosine kinase inhibitors (TKIs) dramatically alter the natural history of the disease, improving 10-year overall survival (OS) from 20 to 80–90%.[3][4][5][6]
Natural History
If left untreated, majority of patients with chronic myelogenous leukemia may progress from a chronic phase where differentiation is reasonably well-maintained to blast or acute phase (BP) where differentiation is lost. the progression to BP occurs at a median of 3–5 years from diagnosis in untreated patients. Without treatment, the patient will develop symptoms of anemia, excess bleeding, enlarged spleen, and infection which may eventually lead to death.
Complications
Chronic myelogenous leukemia may lead to the following complications:[7][8]
- Recurrent bleeding
- Fatigue
- Enlarged spleen
- Anemia
- Weight loss
- Myeloid sarcoma
- Skin changes
- Leukemia cutis
- Leukemic cells enter the skin. The sores or patches can be any size and are usually pink or tan in color.
- Sores usually appear on the extremities
- Sweet's syndrome (acute febrile neutrophilic dermatosis)
- Fever
- Painful sores that may appear anywhere on the body
Prognosis
Prognosis is generally good. Between 2004 and 2010, the 5-year relative survival of patients with CML was 59.9%. When associated with old age, the 5-year survival rate of patients with chronic myelogenous leukemia was 80.2% and 37.1% for patients <65 and ≥ 65 years of age, respectively.[1]
The prognosis and treatment options depend on the following:[7]
- The patient’s age
- Elderly people have a less favorable prognosis
- The phase of CML
- Accelerated or blast phase at the time of diagnosis is a less favorable prognostic factor
- The amount of blasts in the blood or bone marrow
- A high number of blasts in the blood or bone marrow at diagnosis is a less favorable prognostic factor
- The size of the spleen at diagnosis
- Splenomegaly at diagnosis is a less favorable prognostic factor
- Platelet count
- Thrombocytopenia or thrombocytosis at diagnosis is a less favorable prognostic factor
- Eosinophils and basophils
- A higher number of eosinophils and basophils in the blood samples indicates a less favorable prognosis
- The Philadelphia chromosome
- Patients with Philadelphia chromosome (Ph+) at diagnosis have a more favorable prognosis than those who do not have the Philadelphia chromosome (Ph-)
- Presence of anemia at diagnosis is a less favorable prognostic factor
- Bone marrow involvement
- A large number of leukemia cells in the bone marrow at the time of diagnosis is a less favorable prognostic factor
- Performance status
- People with a low performance status at the time of diagnosis have a less favorable prognosis
- Serum lactate dehydrogenase blood level
- High serum lactate dehydrogenase (LDH) in the blood is a less favorable prognostic factor
- Response to treatment
- The treatment is effective if a person has a major cytogenetic response after treatment, which means that less than 30% of a person’s blood cells have the Philadelphia chromosome. A major cytogenetic response occurs in about 50–70% of people considered to have good-risk disease (favorable prognostic factors) and in 20% of people considered to have poor-risk disease (unfavorable prognostic factors).
- The patient’s general health
References
- ↑ 1.0 1.1 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.
- ↑ National Cancer Institute. Physician Data Query Database 2015.http://www.cancer.gov/types/leukemia/hp/cml-treatment-pdq#link/_381_toc
- ↑ Jabbour E, Kantarjian H (November 2012). "Chronic myeloid leukemia: 2012 update on diagnosis, monitoring, and management". Am. J. Hematol. 87 (11): 1037–45. doi:10.1002/ajh.23282. PMID 23090888.
- ↑ Radivoyevitch T, Jankovic GM, Tiu RV, Saunthararajah Y, Jackson RC, Hlatky LR, Gale RP, Sachs RK (March 2014). "Sex differences in the incidence of chronic myeloid leukemia". Radiat Environ Biophys. 53 (1): 55–63. doi:10.1007/s00411-013-0507-4. PMC 3943788. PMID 24337217.
- ↑ Deininger MW (2015). "Diagnosing and managing advanced chronic myeloid leukemia". Am Soc Clin Oncol Educ Book: e381–8. doi:10.14694/EdBook_AM.2015.35.e381. PMID 25993200.
- ↑ Thompson PA, Kantarjian HM, Cortes JE (October 2015). "Diagnosis and Treatment of Chronic Myeloid Leukemia in 2015". Mayo Clin. Proc. 90 (10): 1440–54. doi:10.1016/j.mayocp.2015.08.010. PMC 5656269. PMID 26434969.
- ↑ 7.0 7.1 7.2 Canadian Cancer Society.2015.http://www.cancer.ca/en/cancer-information/cancer-type/leukemia-chronic-myelogenous-cml/finding-cancer-early/?region=ab
- ↑ Medline Plus.2015.https://www.nlm.nih.gov/medlineplus/ency/article/000570.htm