OVERVIEW of

CHRONIC
MYELOGENOUS
LEUKEMIA
Form of leukemia characterized by the increased and
unregulated growth of myeloid cells in the bone marrow
and the accumulation of these cells in the blood

The Ph chromosome
CML is linked to a genetic mutation, the
Philadelphia (Ph) chromosome
The Ph chromosome carries a defective gene called BCR-ABL,
which produces a protein that triggers the bone marrow to keep
making abnormal white blood cells

Signs & symptoms Risk Factors

Symptoms of CML are insidious, changing The chromosomal swapping that creates the
somewhat as the disease progresses Philadelphia chromosome can occur in anyone.
The only identified risk factors for CML are:

WEAKNESS FATIGUE FEVER

AGE MALE GENDER RADIATION

It appears more CML is more common EXPOSURE
commonly in the elderly in males than in Rate of CML seems to
SPLENOMEGALY NIGHTSWEATS WEIGHT LOSS with a median age at females (male to peak about 10 years
diagnosis of 65 years female ratio of 1.4:1) after the exposure

Diagnosis

COMPLETE BLOOD COUNT PERIPHERAL BLOOD SMEAR BONE MARROW ANALYSIS

Hyperleukocytosis with mildly increased
basophils and eosinophils, Normochromic,
normocytic anemia, Thrombocytopenia,
Leukoeythroblastosis, Early myeloid cells
Reciprocal translocation of chromosomal
material between chromosomes 9 and 22,
BCR/ABL mutation, Expansion of the myeloid
cell line, Increased megakaryocytes, Mild
fibrosis in the reticulin stain

Treatment decisions for patients with CML are complex and factors influencing
Treatment Options the choice of therapy include the phase of CML, availability of donor, age and
presence of co-morbidities

BCR-ABL TYROSINE INTERFERON ALFA CHEMOTHERAPY STEM CELL

KINASE INHIBITORS May be used in combination TRANSPLANT
First line of therapy with TKI for refractory cases Only proven cure for CML
e.g. Imatinib mesylate

GROUP 12-3A (INDIGO)