Summary
Definition
History and exam
Key diagnostic factors
- splenomegaly
- shortness of breath
- left upper quadrant discomfort or fullness
- epistaxis
- arthralgia
- sternal tenderness
Other diagnostic factors
- weight loss
- excessive sweating
- fever
- pallor
- bruising
- retinal hemorrhages
Risk factors
- age 65 to 74 years
- ionizing radiation exposure
- male sex
Diagnostic tests
1st tests to order
- CBC
- complete metabolic profile
- peripheral blood smear
- bone marrow aspirate and biopsy for cytogenetic analysis
- quantitative reverse transcription PCR (qRT-PCR) including breakpoint analysis
- fluorescence in situ hybridization (FISH)
Tests to consider
- mutational analysis
Treatment algorithm
chronic phase
accelerated phase
Contributors
Authors
Michael J. Mauro, MD
Leader, Myeloproliferative Neoplasms Program, Leukemia Service
Attending Physician and Member
Memorial Sloan Kettering Cancer Center
Professor, Weill Cornell Medicine
New York
NY
Disclosures
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.
Acknowledgements
Dr Michael Mauro would like to gratefully acknowledge Dr Tim Somervaille, Dr Han Myint, and Dr Robert Chen, the previous contributors to this topic.
Disclosures
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
Winston-Salem
NC
Disclosures
RC declares that she has no competing interests.
Richard E. Clark, MA, MD, FRCP, FRCPath
Professor of Haematology
Royal Liverpool University Hospital
Liverpool
UK
Disclosures
None disclosed.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: chronic myeloid leukemia [internet publication].Full text
Hochhaus A, Baccarani M, Silver RT, et al. European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia. Leukemia. 2020 Apr;34(4):966-84.Full text Abstract
Hochhaus A, Saussele S, Rosti G, et al. Chronic myeloid leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017 Jul 1;28(Suppl 4):iv41-51.Full text Abstract
Smith G, Apperley J, Milojkovic D, et al. A British Society for Haematology guideline on the diagnosis and management of chronic myeloid leukaemia. Br J Haematol. 2020 Oct;191(2):171-93.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Leukemoid reaction
- Benign neutrophilic leukocytosis
- Atypical CML
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: chronic myeloid leukemia
- NCCN clinical practice guidelines in oncology: hematopoietic cell transplantation (HCT)
More GuidelinesCalculators
EUTOS long-term survival (ELTS) score
Sokal score for chronic myeloid leukemia
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