Difference between revisions of "Chronic myeloid leukemia"

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Chronic myeloid leukaemia (CML) is a type of [[myeloproliferative neoplasm,]] [[AKA]] ''chronic myelogenous leukemia''. It is driven by the bcr-abl fusion protein, detectable cytogenetically as the Philadelphia chromosome. It is a [[leukemia]] in that the fusion protein drives granulopoiesis (and less commonly megakaryopoiesis), resulting in marked peripheral blood leucocytosis.
'''Chronic myeloid leukaemia''', abbreviated '''CML''', is a type of [[myeloproliferative neoplasm]]. It is also known as '''chronic myelogenous leukemia'''.  


===General===
It is driven by the bcr-abl fusion protein, detectable cytogenetically as the Philadelphia chromosome. It is a [[leukemia]] in that the fusion protein drives granulopoiesis (and less commonly megakaryopoiesis), resulting in marked peripheral blood leucocytosis.
*Adults - usu. 50s or 60s.
 
==General==
*Adults - usually 50s or 60s.


Clinical - commonly:<ref>{{Ref PCPBoD8|336}}</ref>
Clinical - commonly:<ref>{{Ref PCPBoD8|336}}</ref>
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*Myeloblast (common granulocyte precursor) -> promyelocyte -> metamyelocyte -> myelocyte -> band -> mature myelocyte.<ref name=hemechart>URL: [http://commons.wikimedia.org/wiki/File:Hematopoiesis_%28human%29_diagram.png http://commons.wikimedia.org/wiki/File:Hematopoiesis_%28human%29_diagram.png]. Accessed on: 14 January 2012.</ref>
*Myeloblast (common granulocyte precursor) -> promyelocyte -> metamyelocyte -> myelocyte -> band -> mature myelocyte.<ref name=hemechart>URL: [http://commons.wikimedia.org/wiki/File:Hematopoiesis_%28human%29_diagram.png http://commons.wikimedia.org/wiki/File:Hematopoiesis_%28human%29_diagram.png]. Accessed on: 14 January 2012.</ref>


===Microscopic===
==Microscopic==
Features:
Features:
*Bone marrow with too many granulocytes/granulocyte precursors.
*Bone marrow with too many granulocytes/granulocyte precursors.
Line 29: Line 31:
**#Band - dia. 1x mature, 30-40% nucleus - C shape/irregular, no nucleolus.
**#Band - dia. 1x mature, 30-40% nucleus - C shape/irregular, no nucleolus.


===IHC===
==IHC==
Features:<ref>{{Cite journal  | last1 = Muñoz | first1 = L. | last2 = Bellido | first2 = M. | last3 = Sierra | first3 = J. | last4 = Nomdedéu | first4 = JF. | title = Flow cytometric detection of B cell abnormal maturation in chronic myeloid leukemia. | journal = Leukemia | volume = 14 | issue = 2 | pages = 339-40 | month = Feb | year = 2000 | doi =  | PMID = 10673756 |URL = http://www.nature.com/leu/journal/v14/n2/full/2401549a.html }}</ref> (???)
Rarely required. CML may transform into a blast phase, typically myeloid blasts, but lymphoblasts may also be seen. These blasts are typically CD34 and/or CD117 positive. The myeloid blasts will express myeloid markers and the lymphoblasts will shows lymphoid markers.
*Chronic:
**CD20+ CD19+ CD10-.
*Accelerated:
**CD20+ CD19+ CD10+.
*Blast:
**CD20- CD19+ CD10+.  
**CD34+ TdT+.<ref>URL: [http://path.upmc.edu/cases/case271.html http://path.upmc.edu/cases/case271.html]. Accessed on: 14 January 2012.</ref>


===Molecular===
==Molecular==
*t(9;22) BCR-ABL - '''required for diagnosis'''.
*t(9;22) BCR-ABL - '''required for diagnosis'''.
**May be found in other leukemias.
**May be found in other leukemias.
==See also==
*[[Leukemia]].
==References==
{{Reflist|1}}


[[Category: Hematopathology]]
[[Category: Hematopathology]]

Latest revision as of 23:57, 27 May 2018

Chronic myeloid leukaemia, abbreviated CML, is a type of myeloproliferative neoplasm. It is also known as chronic myelogenous leukemia.

It is driven by the bcr-abl fusion protein, detectable cytogenetically as the Philadelphia chromosome. It is a leukemia in that the fusion protein drives granulopoiesis (and less commonly megakaryopoiesis), resulting in marked peripheral blood leucocytosis.

General

  • Adults - usually 50s or 60s.

Clinical - commonly:[1]

  • Leukocytosis - neutrophils, myelocytes, metamyelocytes, +/-eosinophilia, +/-basophilia.

Progression:

  1. Chronic phase - potentially curable.
  2. Accelerated phase.
  3. Blast crisis.

Treatment:

Notes:

  • Myeloblast (common granulocyte precursor) -> promyelocyte -> metamyelocyte -> myelocyte -> band -> mature myelocyte.[2]

Microscopic

Features:

  • Bone marrow with too many granulocytes/granulocyte precursors.
    • Granulocyte precursors:[2]
      1. Myeloblast (common granulocyte precursor) ~ 90% nucleus, multiple nucleoli.
        • Should be less than 10%.
      2. Promyelocyte (committed to a specific linage (neutrophil, basophil or eosinophil)) - dia. 2x mature, 40-50% nucleus, one nucleolus.
      3. Metamyelocyte - dia. 2x mature, 30-40% nucleus, no nucleolus.
      4. Myelocyte - dia. 1x mature, 50-60% nucleus - kidney bean shape, no nucleolus.
      5. Band - dia. 1x mature, 30-40% nucleus - C shape/irregular, no nucleolus.

IHC

Rarely required. CML may transform into a blast phase, typically myeloid blasts, but lymphoblasts may also be seen. These blasts are typically CD34 and/or CD117 positive. The myeloid blasts will express myeloid markers and the lymphoblasts will shows lymphoid markers.

Molecular

  • t(9;22) BCR-ABL - required for diagnosis.
    • May be found in other leukemias.

See also

References

  1. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 336. ISBN 978-1416054542.
  2. ↑ 2.0 2.1 URL: http://commons.wikimedia.org/wiki/File:Hematopoiesis_%28human%29_diagram.png. Accessed on: 14 January 2012.
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