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CML CASE STUDY #4

Chronic myeloid leukemia (CML) is a type of cancer originating in blood-forming cells of the bone marrow, characterized by the presence of the Philadelphia chromosome in about 95% of cases. Risk factors include high-dose radiation exposure, age, and sex, with a higher prevalence in men. Diagnosis involves tests like complete blood count, bone marrow aspiration, and cytogenetics, while treatment options include targeted therapy, chemotherapy, and stem cell transplants.

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13 views2 pages

CML CASE STUDY #4

Chronic myeloid leukemia (CML) is a type of cancer originating in blood-forming cells of the bone marrow, characterized by the presence of the Philadelphia chromosome in about 95% of cases. Risk factors include high-dose radiation exposure, age, and sex, with a higher prevalence in men. Diagnosis involves tests like complete blood count, bone marrow aspiration, and cytogenetics, while treatment options include targeted therapy, chemotherapy, and stem cell transplants.

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Melvin John Duran
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© © All Rights Reserved
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1. What is chronic myeloid leukemia (CML), and what are its common features?

- Chronic myeloid leukemia (CML) is also known as chronic myelogenous leukemia. It's a type
of cancer that starts in certain blood-forming cells of the bone marrow. It was the first
malignancy to be associated with a specific chromosome, approximately 95% of patients were
found to have the Philadelphia chromosome. The Philadelphia chromosome (derivative
chromosome 22) is characterized by a balanced translocation between the long arms of
chromosomes 9 and 22. At the molecular level, the gene for ABL1, an oncogene on
chromosome 9, joins a gene on chromosome 22 named BCR. In CML, a genetic change takes
place in an early (immature) version of myeloid cells the cells that make red blood cells,
platelets, and most types of white blood cells. The leukemia cells grow and divide, building up in
the bone marrow and spilling over into the blood. In time, the cells can also settle in other parts
of the body, including the spleen.

2. What are the risk factors associated with CML?


- The risk of getting chronic myeloid leukemia does not seem to be affected by smoking, diet,
exposure to chemicals, or infections and chronic myeloid leukemia does not run in families. The
only risk factors for chronic myeloid leukemia are:

 Radiation exposure: Being exposed to high-dose radiation increases the risk of getting
CML
 Age: The risk of getting CML goes up with age
 Sex: Leukemia is more common in men than women. CML that is slightly more common
in males than in females.

3.What are the diagnostic tests used to confirm CML in the patient?

 Complete blood count (CBC)- is a test that measures the levels of different cells, like
red blood cells, white blood cells, and platelets, in your blood. Most people with CML
have too many white blood cells with a lot of early (immature) cells called
myeloblasts or blasts.
 Bone marrow aspiration- a thin, hollow needle is inserted into the bone, and a
syringe is used to suck out a small amount of liquid bone marrow.
 Bone marrow biopsy- done just after the aspiration. A small piece of bone and
marrow is removed with a slightly larger needle that is pushed down into the bone.
 Conventional cytogenetics- This test looks at chromosomes under a microscope to
find any changes. The leukemia cells in many CML patients contain an abnormal
chromosome called the Philadelphia (Ph) chromosome, which looks like a shortened
version of chromosome 22.

4. What are the phases of CML, and how do they differ clinically and cytogenetically?

 Chronic phase- Have less than 10% blasts in their blood or bone marrow samples. Have
fairly mild symptoms and usually respond to standard treatments. Most patients are
diagnosed in the chronic phase.

 Accelerated phase- May have symptoms such as fever, poor appetite, and weight loss.
CML in the accelerated phase doesn't respond as well to treatment as CML in the
chronic phase.
- The blood samples have 15% or more, but fewer than 30% blasts
- Basophils make up 20% or more of the blood
- Blasts and promyelocytes combined make up 30% or more of the blood
- Very low platelet counts (100 x 1,000/mm3 or less) that are not caused by
treatment
- New chromosome changes in the leukemia cells with the Philadelphia
chromosome
 Blast phase (aka acute phase / blast crisis)- Bone marrow or blood samples from a
patient in this phase have 20% or more blasts. Large clusters of blasts are seen in the
bone marrow. The blast cells have spread to tissues and organs beyond the bone
marrow. These patients often have fever, poor appetite, and weight loss. In this phase,
the CML acts a lot like an acute leukemia

5. What are the treatment options for CML?


- Treatment of chronic phase chronic myelogenous leukemia may include the following:
 Targeted therapy with a tyrosine kinase inhibitor (imatinib mesylate, nilotinib, dasatini,
bosotinib).
 High-dose chemotherapy with donor stem cell transplant
 Chemotherapy
 Splenectomy
 A clinical trial of lower-dose chemotherapy with donor stem cell transplant.

Reference:
Rodak, B.F., Fritsma, G.A., & Keohane, E.M. (2013). Hematology. Clinical Principles and
Applications. 4th edition. Page 455. Elsevier.
Rodak, B.F., Fritsma, G.A., & Keohane, E.M. (2013). Hematology. Clinical Principles and
Applications. 4th edition. Page 513-514. Elsevier.
What is chronic myeloid leukemia? | Leukemia types. (n.d.). American Cancer Society.
https://www.cancer.org/cancer/types/chronic-myeloid-leukemia/about/what-is-cml.html
Treating chronic myeloid leukemia. (n.d.). American Cancer Society.
https://www.cancer.org/cancer/types/chronic-myeloid-leukemia/treating.html
Chronic myeloid leukemia causes, risk factors, and prevention. (n.d.). American Cancer Society.
https://www.cancer.org/cancer/types/chronic-myeloid-leukemia/causes-risks-prevention.html

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