CHRONIC MYELOGENOUS LEUKEMIA
translocation the long arms of
 Is a MPN arising from a single genetic
translocation in a pluripotential
hemapoetic stem cell producing a clonal
overproduction of myeloid cell line in a
cell line resulting in a preponderance of
immature cells in the neutrophilic line
CLINICAL FEATURES
‣Infection
‣Anemia
‣Bleeding
‣splenomegaly
INCIDENCE
 It occurs predominantly in 46-53 y/o.
 Slightly more common in males than
females
 Carried also a mortality rate of 1,5 per
100,000yearly prior to the development
of imatinib meslate(tyrosine kinase
inhibitor that is a treatment for CML).
 eventually transform into leukemia and
Symptoms associated with clinical onset
 Fatigue
 Decreased tolerance of exertion
 Anorexia
 Abdominal discomfort
 Weight loss
 Symptomatic splenic enlargement
Cytogenetics of Philadelphia chromosome
 A unique chromosome that is present in
proliferating hematopoietic stem cells
and their progany in hematopoetic
stem cell must be identified to confirm
diagnosis.
 it appears that Philadelphia
chromosome is more frequently in
population exposed to ionizing
radiation.
 Appearance of the Philadelphia
chromosome in donor cells after
allogeneic bone marrow transplantation
indicates a possibility of a transmissable
agent.
 Philadelphia chromosome is reciprocal
chromosome 9 and 22 which produces
the BRC/ABL1 chimeric gene(produces
a 210-kD BRC/ABL fussion protein that
enhanced tyrosine kinase activity).
Peripheral blood and bone marrow
 There are dramatic morphologic
changes in peripheral blood and bone
marrow that reflect the expansion of
the granulocyte pool, particularly in
maturational stages.
Other laboratory findings
 Hyperuricemia and uricosuria maybe
associated with secondary gout(due to
cell increased turnover), urinary uric
acid stones, uric acid nephropathy.
PROGRESSION
 Most cases of this disease would
some patient proceed through a
intermediate metamorphosis or
accelerated phase.
 Disease progression is accompanied
by:
 Increased in number of clinical
symptoms
 Adverse changes I laboratory values
 Poorer response to therapy than in
the chronic phase
 Blast crisis involve peripheral blood,
bone marrow, extramedullary
tissues
 Based on acute leukemia definitions,
blast constitute more than 20% of
total bone marrow cellularity, and
the peripheral blood exhibits
increased blast.
  Blast crisis leukemia usually is AML
or ALL, but origins from other
hematopoietic clonal cells are
possible.

 Granulocytic sarcoma is an
extramedullary growth that may
occur as lymphocytic or
myelogenous cell proliferations.

Related disease
 Several disease exist that are clinically
similar to CML but do not exhibit the
Philadelphia chromosome and express
only a few pseudo-gaucher cells.
 Chronic neutrophilic leukemia
manifest bone marrow, and
extramedullary infiltrative
pattern similar to CML
 Juvenile myelomonocytic
leukemia observed in children
younger 4 y/o and accompanied
by expansion in number of
monocyte, granulocyte,
immature granulocyte and
manifestation of
dyserythropoiesis.
 adult myelomonocytic leukemia