Chronic myeloid leukaemia

Last reviewed: 7 Jan 2023
Last updated: 21 Apr 2022



History and exam

Key diagnostic factors

  • presence of risk factors
  • splenomegaly
  • shortness of breath
  • left upper quadrant discomfort or fullness
  • epistaxis
  • arthralgia
  • sternal tenderness
More key diagnostic factors

Other diagnostic factors

  • weight loss
  • excessive sweating
  • fever
  • pallor
  • bruising
  • retinal haemorrhages
Other diagnostic factors

Risk factors

  • age 65 to 74 years
  • ionising radiation exposure
  • male sex
More risk factors

Diagnostic investigations

1st investigations to order

  • FBC
  • complete metabolic profile
  • peripheral blood smear
  • bone marrow biopsy
  • cytogenetic studies
  • quantitative reverse transcription PCR (qRT-PCR) including breakpoint analysis
  • fluorescent in situ hybridisation (FISH)
More 1st investigations to order

Treatment algorithm


chronic phase

accelerated phase

blast phase


relapse after allogeneic HSCT or allogeneic HSCT contraindicated



Michael J. Mauro, MD

Leader, Myeloproliferative Neoplasms Program, Leukemia Service

Attending Physician and Member

Memorial Sloan Kettering Cancer Center

Professor, Weill Cornell Medicine



MJM has received institutional research support for clinical trials from Novartis, Bristol Myers Squibb, Takeda, and Sun Pharma/Sparc, and honoraria for consulting/advisory boards from Novartis, Bristol Myers Squibb, Takeda, and Pfizer.


Dr Michael Mauro would like to gratefully acknowledge Dr Tim Somervaille, Dr Han Myint, and Dr Robert Chen, the previous contributors to this topic.


TS has received travel support and speaker expenses from Novartis, and has served as a consultant to Novartis for development of drugs for indications other than CML. HM sits on the advisory board of Novartis and Bristol-Myers Squibb, and also does speaking engagements on their behalf. RC declares that he has no competing interests.

Peer reviewers

Rebecca Connor, MD

Chief Fellow

Section of Hematology and Oncology

Department of Internal Medicine

Wake Forest University Baptist Medical Center




RC declares that she has no competing interests.

Richard E. Clark, MA, MD, FRCP, FRCPath

Professor of Haematology

Royal Liverpool University Hospital




None disclosed.

  • Differentials

    • Leukaemoid reaction
    • Benign neutrophilic leukocytosis
    • Atypical CML
    More Differentials
  • Guidelines

    • NCCN clinical practice guidelines in oncology: chronic myeloid leukemia
    • Suspected cancer: recognition and referral
    More Guidelines
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