CML in English

7/30/2019 CML in English

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Chronic Myelogenous Leukemia

( Chronic Granulocytic Leukemia )


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I. Introduction :

Chronic Myelogenous Leukemia ( CML )

- Belongs to Myeloproliferative Disorders

-Adult & elderly- Relativelyslowclinical progression

- Relatively better live expectancy than acute

leukemia.


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II. Etiology of CML :

Not clear yet.

- Cytotoxic drugs ?

- Viruses ?- Radiation ?

- Pollutants ?


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III. Clinical picture of CML :

Adult & elderly

Male > female

Splenomegaly( Schuffner VII / VIII ) Sometimes hepatomegaly

Complaints : abd. fullness/dyspneu

abdominal massearly satiety


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Clinical progression in CML :

I. ChronicPhase

relatively stabil, lasting months / years

II. Accelerated Phase

decreased clin condition, weeks /months

blood smear : increased of blast cells

III. Blast Crisis Phase

worsened condition & laboratory findings

as an acute leukemia


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Pathogenesis of CML :

Majority : Philadelphia chromosome (+)

t (9:22) : resiprocal transversion of genetic

material from chrom 9 to 22 (vv)new abnormal protein

initiating abnormal proliferation of myeloid cells

in bone-marrowCML.


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Sebuah Kariotip dengan translokasi kromosom 9 dan 22 : Philadelphia chromosome


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IV. Diagnosis of CML :

Clinical pictures : adult/elderly, splenomegaly

Routine blood : Hb low/normal/increased

Platelet normal / increasedWBC quite increased

Blood smear : immature WBC ( blast cells ),

intermediate (rods),mature WBCgranulocytes all are increased


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Peripheral blood smear :

Blast cells < 5 % or

Blast + promyelocytes < 10 %

Other marker : Leukocyte Alkaline Phospatase 60 yo)

- 2. splenomegaly (>10 cm bac)

- 3. blast > 3 % in blood smearor > 5 % in BM

- 4. platelet > 700.000 / mm3

All above are Negative Prognosis Factors


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Life expectancy of CML :

Survival Rate : Median survival 4 yrs

10 % died in the 2nd yr

Yearly after : increased by 20 %


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CML in English