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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:

  • Progressive leukocytosis.

  • Thrombocytosis or thrombocytopenia.

  • Anemia.

  • Increasing and painful splenomegaly or hepatomegaly.

  • Fever.

  • Bone pain.

  • Development of destructive bone lesions.

  • 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:

  • Weight loss, fever, night sweats, and bone pains.

  • Symptoms of anemia, infectious complications, and bleeding are commonly seen.

  • 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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