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'''Chronic myeloid leukaemia''', abbreviated '''CML''', is a type of [[myeloproliferative neoplasm]]. It is also known as '''chronic myelogenous leukemia'''. | |||
[[Category: | 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:<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== | |||
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== | |||
*[[Leukemia]]. | |||
==References== | |||
{{Reflist|1}} | |||
[[Category: Hematopathology]] | |||