Chronic myeloid leukemia
Background
- aka chronic myelogenous leukemia, chronic myelocytic leukemia
- More common in older patients
Clinical Features
Usually progresses through 3 stages
Chronic phase
- Asymptomatic or indolent, nonspecific symptoms
- Malaise, fatigue, weight loss, low grade fever
- Lymphadenopathy, splenomegaly
Accelerated phase
- Worsening of above symptoms due to progressive leukocytosis
- Signs/symptoms of thrombocytopenia (e.g. petechiae, bleeding) or thrombocytosis
Blast crisis
- Behaves like acute leukemia
- Associated with Leukostasis and hyperleukocytosis and Hyperviscosity syndrome
Differential Diagnosis
Oncologic Emergencies
Related to Local Tumor Effects
- Malignant airway obstruction
- Bone metastases and pathologic fractures
- Malignant spinal cord compression
- Malignant Pericardial Effusion and Tamponade
- Superior vena cava syndrome
Related to Biochemical Derangement
- Hypercalcemia of malignancy
- Hyponatremia due to SIADH
- Adrenal insufficiency
- Tumor lysis syndrome
- Carcinoid syndrome
Related to Hematologic Derangement
Related to Therapy
- Chemotherapy-induced nausea and vomiting
- Cytokine release syndrome
- Chemotherapeutic drug extravasation
- Differentiation syndrome (retinoic acid syndrome) in APML
- Stem cell transplant complications
- Catheter-related complications
- Tunnel infection
- Exit site infection
- CVC obstruction (intraluminal or catheter tip thrombosis)
- Catheter-related venous thrombosis
- Fracture of catheter lumen
- Oncologic therapy related adverse events
Evaluation
- CBC-
- Leukocytosis: usually only moderately elevated in chronic phase (20,000-60,000)
- Mild-moderate anemia
- Variable platelet counts
- Peripheral smear
- DIC labs: coags, d-dimer, fibrinogen
- Tumor lysis syndrome labs: BMP, uric acid, phosphate
- Infectious workup
- Evaluate for complications
Management
- See management of Leukostasis and hyperleukocytosis, neutropenic fever, hyperviscosity syndrome, tumor lysis syndrome, thrombocytopenia