Chronic myelogenous leukemia

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Schematic of the Philadelphia Chromosome

Diagram showing which cells CML can start in CRUK 388.svg

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Chronic Myeloid Leukemia smear 2009-04-09

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Hypolobated small megakaryocyte

Chronic myelogenous leukemia (CML), also known as chronic myeloid leukemia, is a type of cancer that originates in the bone marrow and results in the overproduction of white blood cells. It is a form of leukemia, which is a group of cancers that typically begin in the bone marrow and result in high numbers of abnormal white blood cells.

Pathophysiology

CML is characterized by the presence of the Philadelphia chromosome, a specific genetic abnormality in chromosome 22 of human cells. This abnormality is a result of a translocation between chromosome 9 and chromosome 22, which creates the BCR-ABL fusion gene. The BCR-ABL gene produces a protein with tyrosine kinase activity that leads to uncontrolled cell division.

Symptoms

Common symptoms of CML include:

• Fatigue
• Weight loss
• Night sweats
• Fever
• Splenomegaly (enlarged spleen)
• Hepatomegaly (enlarged liver)
• Bone pain

Diagnosis

CML is typically diagnosed through a combination of blood tests, bone marrow biopsy, and cytogenetic analysis. The presence of the Philadelphia chromosome is a key diagnostic marker.

Stages

CML progresses through three phases:

• Chronic phase: The disease progresses slowly and patients may have mild symptoms.
• Accelerated phase: The disease progresses more rapidly and symptoms become more severe.
• Blast crisis: The disease behaves like an acute leukemia with rapid progression and severe symptoms.

Treatment

Treatment options for CML include:

• Tyrosine kinase inhibitors (TKIs) such as imatinib, dasatinib, and nilotinib.
• Chemotherapy
• Stem cell transplant
• Interferon therapy

Prognosis

The prognosis for CML has improved significantly with the advent of tyrosine kinase inhibitors. Many patients achieve long-term remission and have a normal life expectancy.

Epidemiology

CML accounts for about 15-20% of all cases of adult leukemia. It is more common in older adults, with the median age at diagnosis being around 65 years.

See also

• Leukemia
• Bone marrow
• Philadelphia chromosome
• Tyrosine kinase inhibitors