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
利益声明
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.
鸣谢
Dr Michael Mauro would like to gratefully acknowledge Dr Tim Somervaille, Dr Han Myint, and Dr Robert Chen, the previous contributors to this topic.
利益声明
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.
同行评议者
Rebecca Connor, MD
Chief Fellow
Section of Hematology and Oncology
Department of Internal Medicine
Wake Forest University Baptist Medical Center
Winston-Salem
NC
利益声明
RC declares that she has no competing interests.
Richard E. Clark, MA, MD, FRCP, FRCPath
Professor of Haematology
Royal Liverpool University Hospital
Liverpool
UK
利益声明
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.
参考文献
关键文献
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: chronic myeloid leukemia [internet publication].全文
Hochhaus A, Baccarani M, Silver RT, et al. European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia. Leukemia. 2020 Apr;34(4):966-84.全文 摘要
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.全文 摘要
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.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Leukemoid reaction
- Benign neutrophilic leukocytosis
- Atypical CML
更多 鉴别诊断指南
- NCCN clinical practice guidelines in oncology: chronic myeloid leukemia
- NCCN clinical practice guidelines in oncology: hematopoietic cell transplantation (HCT)
更多 指南医学计算器
EUTOS long-term survival (ELTS) score
Sokal score for chronic myeloid leukemia
更多 医学计算器
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