Difference between revisions of "Chronic myeloid leukemia"

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#redirect [[Leukemia#Chronic_myeloid_leukemia]]
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.


[[Category:Diagnosis]]
===General===
*Adults - usu. 50s or 60s.
 
Clinical - commonly:<ref>{{Ref PCPBoD8|336}}</ref>
*Leukocytosis - neutrophils, myelocytes, metamyelocytes, +/-eosinophilia, +/-basophilia.
 
Progression:
#Chronic phase - potentially curable.
#Accelerated phase.
#Blast crisis.
 
Treatment:
*[[Imatinib]] and other [[tyrosine kinase inhibitors]]
 
Notes:
*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===
Features:
*Bone marrow with too many granulocytes/granulocyte precursors.
**Granulocyte precursors:<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) ~ 90% nucleus, multiple nucleoli.
**#*Should be less than 10%.
**#Promyelocyte (committed to a specific linage ([[neutrophil]], basophil or [[eosinophil]])) - dia. 2x mature, 40-50% nucleus, one [[nucleolus]].
**#Metamyelocyte - dia. 2x mature, 30-40% nucleus, no nucleolus.
**#Myelocyte - dia. 1x mature, 50-60% nucleus - kidney bean shape, no nucleolus.
**#Band - dia. 1x mature, 30-40% nucleus - C shape/irregular, no nucleolus.
 
===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> (???)
*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===
*t(9;22) BCR-ABL - '''required for diagnosis'''.
**May be found in other leukemias.
 
[[Category: Hematopathology]]

Revision as of 16:50, 26 May 2018

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.

General

  • Adults - usu. 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

Features:[3] (???)

  • Chronic:
    • CD20+ CD19+ CD10-.
  • Accelerated:
    • CD20+ CD19+ CD10+.
  • Blast:
    • CD20- CD19+ CD10+.
    • CD34+ TdT+.[4]

Molecular

  • t(9;22) BCR-ABL - required for diagnosis.
    • May be found in other leukemias.
  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.
  3. ↑ Muñoz, L.; Bellido, M.; Sierra, J.; Nomdedéu, JF. (Feb 2000). "Flow cytometric detection of B cell abnormal maturation in chronic myeloid leukemia.". Leukemia 14 (2): 339-40. PMID 10673756.
  4. ↑ URL: http://path.upmc.edu/cases/case271.html. Accessed on: 14 January 2012.
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