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 investigations
1st investigations to order
- CBC
- complete metabolic profile
- peripheral blood smear
- bone marrow biopsy
- cytogenetic studies
- quantitative reverse transcription PCR (qRT-PCR) including breakpoint analysis
- fluorescent in situ hybridization (FISH)
Treatment algorithm
chronic phase
accelerated phase
blast phase
relapse after allogeneic HSCT or allogeneic HSCT contraindicated
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
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.
Differentials
- Leukemoid reaction
- Benign neutrophilic leukocytosis
- Atypical CML
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: hematopoietic cell transplantation (HCT)
- NCCN clinical practice guidelines in oncology: chronic myeloid leukemia
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