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Chronic myeloid leukemia
Symptoms and signs
The disease usually has a biphasic, and sometimes triphasic,
course.
Chronic phase
The initial phase is the chronic phase, which is
frequently asymptomatic. Patients with symptoms usually have a
gradual onset of:
- Fatigue, anorexia, weight loss, increased sweating,
- Left upper quadrant discomfort, and early satiety as a result of
splenic enlargement.
- Rare patients with very high counts of white
blood cells (WBCs) may have manifestations of hyperviscosity,
including priapism, tinnitus, stupor, visual changes from retinal
hemorrhages, and even cerebrovascular accidents.
On physical exam,
splenomegaly is the most common finding which is sometimes
associated with liver enlargement. The spleen may be enormous,
filling most of the abdomen and presenting a significant clinical
problem, or the spleen may be only minimally enlarged. In about 10%
of patients, the spleen is neither palpable nor enlarged on splenic
scan.
Accelerated phase
The accelerated phase is an ill-defined transitional
phase that is frequently asymptomatic. The diagnosis is made from
changes in peripheral blood or bone marrow. There is greater than 5%
blasts in the peripheral blood or bone marrow but less than 30%
blasts in both the peripheral blood and bone marrow. Some patients
may have fever, night sweats, and progressive enlargement of the
spleen. At least 20% of patients enter a blastic phase without
evidence of having had accelerated phase.
Signs and symptoms commonly heralding such a change include the
following:
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Progressive leukocytosis.
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Thrombocytosis or thrombocytopenia.
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Anemia.
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Increasing and painful splenomegaly or hepatomegaly.
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Fever.
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Bone pain.
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Development of destructive bone lesions.
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Thrombotic or bleeding complications.
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Blastic phase
The diagnosis of blastic phase requires the presence of
at least 30% of blasts in the bone marrow or peripheral blood.
Patients in the blastic phase are more likely to have
symptoms, including:
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Weight loss, fever, night sweats, and bone
pains.
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Symptoms of anemia, infectious complications, and bleeding
are commonly seen.
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Signs of central nervous system (CNS) leukemia
can also be seen in this phase.
-
In the blastic phase, tissue
infiltration can occur, most frequently to the lymph nodes, skin,
subcutaneous tissues, and bone.
The annual rate of progression from chronic phase to blast crisis
is 5% to 10% in the first 2 years and 20% in subsequent years. At
least 20% of patients enter a blastic phase without evidence of having
had accelerated phase.
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