Chronic Myeloid Leukemia (CML)

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Author: George Girgis MLS(ASCP) CM
Reviewers: Laurie Bjerklie M.Ed., MT(ASCP) & Margaret A. Reinhart MS, MT(ASCP)

Continuing Education Credits

Objectives

  • Define Chronic Myeloid Leukemia (CML).
  • Describe the epidemiology and etiology of CML.
  • Discuss the site of involvement and clinical features of CML.
  • Describe the peripheral blood findings and blood smear morphology for CML cases.
  • Describe the bone marrow morphology in patients with CML.
  • List the disease stages in patients with CML.
  • Discuss immunophenotyping and cytogenetics for CML cases.
  • Outline the prognosis and therapy for patients with CML.

Course Outline

  • An Introduction to Chronic Myeloid Leukemia (CML)
      • Introduction & Definition of Chronic Myeloid Leukemia (CML)
      • Introduction to CML, continued
      • Chronic myeloid leukemia (CML) is caused by which of the following?
      • The Philadelphia (Ph) chromosome is associated with which of the following chromosomal translocations?
      • CML never transforms to acute leukemia.
      • The Philadelphia chromosome is only found in the myeloid cell lines and never in the lymphoid cells.
  • Epidemiology and Etiology of CML
      • Epidemiology & Etiology
      • Etiology, continued
      • Patients with CML may initially have symptoms of weight loss, low-grade fever, night sweats, or no symptoms at all.
      • CML is only a disease of children and is rarely seen in adults.
      • Characteristics of CML include which of the following?
  • Site of Involvement and Clinical Features for CML
      • Sites of Involvement and Clinical Features
      • CML patients in the chronic stage present with very low WBC and platelet counts.
      • Patients with CML-chronic phase never have a large spleen.
  • Peripheral Blood, Blood Smear and Bone Marrow Morphology
      • Morphology of the Peripheral Blood Smear
      • Morphology of the Bone Marrow Aspirate Smear
      • CML - Accelerated Phase (AP)
      • CML- Blastic Phase (BP)
      • Patients with CML in the chronic phase present with all of the following EXCEPT:
      • A patient with CML in the accelerated phase shows which of the following:
  • Immunophenotype and Cytogenetics
      • Immunophenotyping
      • Cytochemical Staining
      • Cytogenetics
      • Leukocyte alkaline phosphatase activity (LAP score) is very strong in CML and weak in leukemoid reaction.
      • Flow cytometry is very valuable in the blastic phase to distinguish myeloid, lymphoid, or mixed phenotype blasts proliferation.
  • Differential Diagnosis
      • Differential Diagnosis
      • Patients with CML and leukemoid reactions present with leukocytosis.
      • CML resembles a leukemoid reaction in many ways and is usually resolved with antibiotics.
  • Prognosis and Therapy
      • Prognosis and Therapy
      • Currently, there is no therapy for CML.
  • References
      • References

Additional Information

Level of instruction: Intermediate
Intended audience: Medical laboratory scientists, medical laboratory technicians, Hematology instructors, MLS students, and other healthcare personnel who have an interest in this subject matter.
Author Information: George Girgis, MLS (ASCP)CM has over 30 years of experience as a Medical Laboratory Scientist, during which he has been a trainer and instructor at Indiana University Health in the field of hematology and hematopathology. George holds a Bachelor of Medicine, Bachelor of Surgery from Ein-Shams University, Cairo, Egypt and a Bachelor of Science in Medical Laboratory Sciences from I.U.P.U.I., Indianapolis, IN.
Reviewer Information:  
Laurie Bjerklie, M.Ed., MT(ASCP), is currently a professor at Rasmussen College in Fargo, ND for their MLT program where she teaches a variety of courses, including hematology and microbiology. She is the former Program Director of the Clinical Laboratory Science program at DeVry University in Phoenix, Arizona. Bjerklie has over ten years of experience in higher education and continues to work part time as a bench tech.
Margaret Reinhart, MS, MT(ASCP) is the MLS Program Director and Senior lecturer in Biological Sciences at the University of the Sciences in Philadelphia PA where she teaches hematology, clinical immunology, parasitology, and other related courses. She is also adjunct instructor in Hematology at Pennsylvania Hospital, Philadelphia PA. She holds a Masters Degree in Biology and in Health Care Administration.

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A peripheral blood smear with a mixed phenotype (small & large blast cells).
A peripheral blood smear with basophils and blast cells as noted by arrows.
Bone marrow aspirate is hypercellular.
Philadelphia Chromosome.svg
FISH probe for bcr/ abl fusion in CML
A diagram depicting Imatinib's therapeutic action (3).