Chronic myeloid leukemia: Difference between revisions
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==Background== | ==Background== | ||
* | *Also known as chronic myelogenous leukemia, chronic myelocytic leukemia | ||
*More common in older patients | *More common in older patients | ||
==Clinical Features== | ==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]], [[hemorrhage|bleeding]]) or [[thrombocytosis]] | |||
===Blast crisis=== | |||
*Behaves like [[acute leukemia]] | |||
*Associated with [[Leukostasis and hyperleukocytosis]] and [[Hyperviscosity syndrome]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Oncologic emergencies DDX}} | {{Oncologic emergencies DDX}} | ||
{{DDX leukocytosis}} | |||
==Evaluation== | ==Evaluation== | ||
*CBC | *CBC | ||
**Leukocytosis: usually only moderately elevated in chronic phase (20,000-60,000) | **[[Leukocytosis]]: usually only moderately elevated in chronic phase (20,000-60,000) | ||
**Mild-moderate [[anemia]] | **Mild-moderate [[anemia]] | ||
**Variable platelet counts | **Variable platelet counts | ||
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==Management== | ==Management== | ||
*See management of [[Leukostasis and hyperleukocytosis]], [[neutropenic fever]], [[hyperviscosity syndrome]], [[tumor lysis syndrome]], [[thrombocytopenia]] | *See management of [[Leukostasis and hyperleukocytosis]], [[neutropenic fever]], [[hyperviscosity syndrome]], [[DIC]], [[tumor lysis syndrome]], [[thrombocytopenia]], [[anemia]] | ||
==Disposition== | ==Disposition== | ||
*Can consider discharging asymptomatic patients in chronic phase who have no complications and close follow-up. Otherwise, admit. | |||
==See Also== | ==See Also== | ||
Latest revision as of 00:11, 1 October 2019
Background
- Also known as 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
Leukocytosis
- Normally responding bone marrow
- Infection
- Inflammation: tissue necrosis, infarction, burns, arthritis
- Stress: overexertion, seizures, anxiety, anesthesia
- Drugs: corticosteroids, lithium, beta agonists
- Trauma: splenectomy
- Hemolytic anemia
- Leukemoid malignancy
- Abnormal bone marrow
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, DIC, tumor lysis syndrome, thrombocytopenia, anemia
Disposition
- Can consider discharging asymptomatic patients in chronic phase who have no complications and close follow-up. Otherwise, admit.