Chronic Myeloid Leukemia: clinical aspects, diagnosis and main changes observed in complete blood count

We report bilateral proptosis as the initial presentation of Acute Myeloid Leukemia (AML) in a child. An Eight year child presented with a history of painless proptosis in the both eyes within 10 days. Radiological investigation (CT scan) showed inltration of orbit with the metastatic tumour cell. AML was diagnosed with complete blood count, General Blood Picture (GBP) and bone marrow biopsy. The presumptive diagnosis of leukemic inltration of the orbit is made. We report this case as AML can rarely present in child as a bilateral proptosis due to leukemic inltration. Urgent treatment modality for this rare condition is radiation.

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Clinical aspects of chronic myeloid leukemia

Chronic Myeloproliferative Disorders ◽

10.3109/9780203091616-8 ◽

2013 ◽

pp. 67-77

Keyword(s):

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Clinical Aspects

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Clinical and Psychological Factors to Consider in Achieving Treatment-Free Remission in Patients With Chronic Myeloid Leukemia

Frontiers in Oncology ◽

10.3389/fonc.2021.631570 ◽

2021 ◽

Vol 11 ◽

Author(s):

Massimo Breccia ◽

Elisabetta Abruzzese ◽

Mario Annunziata ◽

Luigia Luciano ◽

Simona Sica

Keyword(s):

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Kinase Inhibitors ◽

Clinical Aspects ◽

Molecular Response ◽

Multiple Points ◽

Psychological Issues ◽

Therapeutic Goals ◽

Treatment Free Remission

Treatment of chronic myeloid leukemia (CML) has evolved dramatically in recent years. In this regard, the introduction of second-generation tyrosine kinase inhibitors (TKI) has revolutionized therapeutic goals, and it is now desirable to obtain treatment-free remission (TFR), i.e. when a patient who has stopped TKI therapy maintains a major molecular response and does not need to restart treatment. This report summarizes the main findings from a group of expert hematologists in Italy who met to discuss treatment and management of patients with CML with focus on broad-ranging aspects of TFR. A survey was used to obtain information about the clinicians’ experience with TFR and to better understand the clinical and psychological issues that patients and physicians face when considering TFR. The overall goal was to explore the possibility of discontinuing treatment from multiple points of view, considering both clinical aspects of TFR as well as psychological management of patients. Practical information is provided on aspects associated with initiating TFR, clinical data supporting it, the role of monitoring, and management of discontinuation-related adverse events. This publication outlines many of the shortcomings and highlights proposed solutions for routine clinical practice, and provides an overview of the literature relative to TFR.

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Chronic myeloid leukemia revealed by bilateral proliferative retinopathy: A case report and literature review

GSC Advanced Research and Reviews ◽

10.30574/gscarr.2021.7.1.0090 ◽

2021 ◽

Vol 7 (1) ◽

pp. 157-160

Author(s):

Wafa Quiddi ◽

Hiba Boumaazi ◽

Sanae Sayagh

Keyword(s):

Case Report ◽

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Complete Blood Count ◽

Case Reports ◽

Rare Complication ◽

Philadelphia Chromosome ◽

Vitreous Hemorrhage ◽

Interesting Case ◽

Proliferative Retinopathy

Bilateral proliferative retinopathy is a rare complication of chronic myeloid leukemia (CML) as a few case reports have been published to date. In this case report, a 32-year old diabetic female presented with history of bilaterally decreased vision. Ophthalmologic examination showed bilateral proliferative retinopathy (i.e., retinal detachment, vitreous hemorrhage, pre-retinal fibrosis and the presence of bilateral peripheral capillary dropout with multiple retinal sea fan neovascularization) for which panretinal laser photocoagulation and vitrectomy were planned. During the preoperative workup, complete blood count revealed hyperleukocytosis. Later on, the karyotype analysis identified Philadelphia chromosome, confirming the diagnosis of CML. Hence, it was an interesting case where bilateral proliferative retinopathy directed to the diagnosis of CML. Therefore, proliferative retinopathy may be the first presentation of CML.

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A Rare Case of Synchronous us Carcinoma Breast with Chronic Myeloid Leukemia

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i51b33546 ◽

2021 ◽

pp. 299-305

Author(s):

Varun S. Kulkarni ◽

Anurag Bhattacharjee ◽

Harshal Ramteke ◽

Abhishek Gupta ◽

Shubham Durge ◽

...

Keyword(s):

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Rare Case ◽

Ductal Carcinoma ◽

Complete Blood Count ◽

Adult Population ◽

Abdominal Mass ◽

Left Breast ◽

Female Ratio ◽

Carcinoma Breast

Chronic myeloid leukemia is an insidiously progressive condition and comparatively rare type of blood cell malignancy that begins in the bone marrow. Chronic myeloid leukemia typically affects adult population and is documented to be caused by chromosomal mutation that usually occurs spontaneously. Chronic myeloid leukemia is more common in males than in females (male: female ratio of 1.4:1) and appears more commonly in the elderly with a median age at diagnosis of 65 years [1] Exposure to ionising radiation is one of the risk factors, based on a 50 fold higher incidence of CML in Hiroshima and Nagasaki nuclear bombing survivors [1] The rate of CML in these individuals seems to reach at its peak about 10 years after the exposure [1]. Carcinoma breast on the other hand is one of the most common causes of death in middle aged women in western countries. There are numerous factors contributing as its etiological factors such as age, gender, diet, endocrinal factors, previous radiation exposure, genetic factors and geographical factors. We present a case report of a 44 old female who came to Acharya Vinoba Bhave Rural Hospital (Datta Meghe Institute of Medical Sciences and Research), with presenting complaint of lump in the left breast since 2 days and abdominal mass for 1 month. On investigations, patient was diagnosed with a rare case of chronic myeloid leukemia on the complete blood count and peripheral smear and the lump in the left breast also revealed invasive ductal carcinoma of the left breast.

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Epidemiological Approach of Chronic Myeloid Leukemia. Algerian-Tunisian Study

Blood ◽

10.1182/blood.v128.22.5440.5440 ◽

2016 ◽

Vol 128 (22) ◽

pp. 5440-5440

Author(s):

K Djouadi ◽

N Abdennebi ◽

F Harieche ◽

R Ahmed Nacer ◽

RM Hamladji ◽

...

Keyword(s):

Chronic Myeloid Leukemia ◽

Molecular Biology ◽

Prevalence Rate ◽

Myeloid Leukemia ◽

Blood Count ◽

Blood Smear ◽

Average Rate ◽

Tunisian Population ◽

Intermediate Risk ◽

Epidemiological Approach

Abstract Introduction: Chronic myeloid leukemia (CML) accounts for 7%-15% of all leukemias affecting adults. The incidence in Algeria is 0.4/100,000 inhabitants in 2009. The aim of this study is to establish an Algerian-Tunisian epidemiological approach of CML and to know the characteristics of the disease in both countries. Materials and methods: This is a retrospective, longitudinal and multicenter study, including Algerian and Tunisian patients with CML diagnosed between January 2010 and December 2014. Through a data form distributed to various hematology departments, we collected and analyzed the following information: Patient's general characteristics, profession, circumstances of discovery of the disease, clinical and para-clinical examinations outcomes at the time of diagnosis including blood count, blood smear, bone marrow aspiration, cytogenetics, molecular biology, stages of the disease and the Sokal and Eutos prognostic classification scores. Bio-statistical tests: incidence, prevalence and rate of prevalence or relative prevalence (reported to 100,000 inhabitants / year). The descriptive analysis of quantitative and qualitative variables as percentages and 95% confidence interval. The Chi2 test is used to compare two variables. Results: We collected 1349 cases, including 325 from 06 Tunisian hematology units and 1024 from 18 Algerian units. The incidence in the Algerian-Tunisian population was 0.67/100,000 inhabitants with a prevalence rate of 2.72/100,000 inhabitants. The incidence in Tunisia was 0.50 / 100,000 inhabitants with a prevalence of 227 cases in 2014. In Algeria the incidence was 0.53/100,000 inhabitants with a prevalence of 1030 in 2014. The median age is 48 years (03-90) with a peak incidence in the age group (45-49 ans) and slight male predominance (sex ratio: 1,2). There was any notion of risk exposure. The average time between the start of the unrest and the date of diagnosis is 127 days (1-667). The circumstances of discovery: fortuitous in 30.5% (n = 355), splenomegaly in 39.7% (n = 463), asthenia in 24.6% (n = 287), a complication in 8.4% (n =95). Clinical examination includes general signs in 424 cases (36.4%): Weight loss 22.6% (n = 263), profuse sweating 13.8% (n = 13, 8%), bone pains found in 7.8%, splenomegaly in 81.7% (n = 952) with an overhang splenic average of 11.5 ± 5.3 cm (1-28), cutaneous and subcutaneous bleeding: 13.5% (n = 97), thrombosis 0.9% (n = 09). Biological characteristics: the Complete blood count (n = 1185) shows a white blood cells average rate of 171,223 G/L (34,700-984,800), hemoglobin average rate of 10.2 g/dl (4-17), platelets at 394,070 g/l (85-1340). Blood smear 96.3% (n = 1121): the average myelemia was 43.2% (10-98%). The Myelogram is practiced in 55% (n = 641), the average rate of the granular 76,5% (40-99%), erythroblasts 10.5% (0-82%), average blasts 3.6%. The karyotype 38.1% (n = 444), the Philadelphia chromosome was found in 423 cases (95, 3%); additional abnormalities were found in 17 cases (3.8%). The Fish was practiced in 281 cases (24.1%) and transcribed bcr/abl was found in 257 cases (91.4%). Molecular biology is practiced in 672 cases (57.7%) the transcript bcr/abl is found in 100%, the transcript of the type is specified in 373 cases, it is kind of b2a2 in 159 cases (42.6%), a b3a2 type in 180 cases (48.3%) and other transcribed in 34 cases (9.1%). CML chronic phase is diagnosed in 88.8% (n = 1051), acceleration phase in 9% (n = 107) acutisation phase in 3.1% (= 37). The distribution of pts according to Sokal prognostic classification (n = 948) describes a predominance of intermediate risk in 54% (n = 511), high risk in 30.3% (n = 287) and low risk in 16% (n = 152). The Eutos score is specified in 769 cases (66%), it is less than 87 in 661 cases (86%) and more than 87 in 108 cases (14%). Conclusion: The incidence of CML in the Algerian-Tunisian population is 0.67/100,000 population with a prevalence rate of 2.72/100,000 inhabitants. The young adult is more affected with a peak incidence between 45 and 49. The average time between the onset of the disease and the diagnosis remains long and the delay probably explains the frequency of tumor forms encountered in Algeria and the prevalence of high and intermediate risk, according to Sokal prognostic classification. Disclosures No relevant conflicts of interest to declare.

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The effect of eltrombopag in managing thrombocytopenia associated with tyrosine kinase therapy in patients with chronic myeloid leukemia and myelofibrosis.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18539 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18539-e18539

Author(s):

Mahran Shoukier ◽

Hagop M. Kantarjian ◽

Jorge E. Cortes ◽

Elias Jabbour ◽

Farhad Ravandi ◽

...

Keyword(s):

Platelet Count ◽

Chronic Myeloid Leukemia ◽

Tyrosine Kinase ◽

Myeloid Leukemia ◽

Complete Blood Count ◽

Chronic Phase ◽

Platelet Response ◽

Treatment Interruptions ◽

Grade 3 ◽

Persistent Thrombocytopenia

e18539 Background: Tyrosine kinase inhibitors (TKIs) are standard therapy for chronic phase (CP) chronic myeloid leukemia (CML). Up to have patients with CML may develop grade ≥3 thrombocytopenia, leading to treatment interruptions and dose reductions. Similarly, management of thrombocytopenia in myelofibrosis (MF) can be challenging because the condition may result in dose adjustments and interruptions of ruxolitinib. Methods: We conducted a non-randomized, phase II, single-arm study to determine the efficacy of eltrombopag for patients with CML or MF with persistent thrombocytopenia during therapy with a TKI or ruxoltinib. We enrolled 15 CML patients with persistent grade ≥3 thrombocytopenia (platelets ≤50 x 109/l) and six MF patients with platelets < 100 x 109/l after at least 3 months of therapy with a TKI or ruxolitinib. Patients received eltrombopag at a starting dose of 50 mg daily, with dose escalation to a maximum of 300 mg daily according to platelet response. Patients were followed with a weekly complete blood count until a stable platelet count was achieved. The target response was a complete response, defined as a platelet count ≥50 x 109/l for CML and ≥100 x 109/l for MF in at least 30% of subjects, sustained for 3 months while continuing TKIs or ruxolitinib therapy. Results: We enrolled 21 patients (CML = 15, MF = 6), with a median age of 60 years (range, 31-99 years). The median platelet count was 44 (range, 3-49) in patients with CML and 62 (range, 25-91) in those with MF. After a median duration of treatment of 18 months (range, 5-77 months), 11 of the 15 patients with CML achieved a complete platelet response at eltrombopag doses of 50–300 mg per day. The median peak platelet count among responders was 133 (range, 6-1225) x 109/l. Nine patients with CML experienced an improvement in cytogenetic response. In 5 patients with CML, the TKIs dose was increased and maintained while continuing eltrombopag. None of the 5 patients with MF had a sustained increase in platelet count to ≥100 x 109/l. No progression of disease was documented in any patient. Therapy was generally well tolerated. One patient (CML) discontinued therapy secondary to toxicity (persistent transaminitis with an accompanying lack of response). Conclusions: Eltrombopag demonstrated clinical efficacy in some patients with CML who were treated with TKIs. No similar benefit was observed in patients with MF who were treated with ruxolitinib. Eltrombopag might be a useful adjunct for patients with CML experiencing persistent thrombocytopenia. Clinical trial information: NCT01428635.

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CNS Involvement in AML Patient Treated with 5-Azacytidine

Case Reports in Hematology ◽

10.1155/2014/937203 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Diamantina Vasilatou ◽

Sotirios Papageorgiou ◽

Efthymia Bazani ◽

Athina Prasouli ◽

Christina Economopoulou ◽

...

Keyword(s):

Central Nervous System ◽

Myeloid Leukemia ◽

Poor Prognosis ◽

Blood Count ◽

Clinical Presentation ◽

Complete Blood Count ◽

Rare Complication ◽

Altered Mental Status ◽

Cns Involvement ◽

Acute Myeloid

Central nervous system (CNS) involvement in acute myeloid leukemia (AML) is a rare complication of the disease and is associated with poor prognosis. Sometimes the clinical presentation can be unspecific and the diagnosis can be very challenging. Here we report a case of CNS infiltration in a patient suffering from AML who presented with normal complete blood count and altered mental status.

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Introduction of a Treatment Approach for Chronic Myeloid Leukemia and Pregnancy Considering Leukemic Burden and Pregnancy Terms

Blood ◽

10.1182/blood.v126.23.5144.5144 ◽

2015 ◽

Vol 126 (23) ◽

pp. 5144-5144 ◽

Cited By ~ 2

Author(s):

Ekaterina Chelysheva ◽

Anna Turkina ◽

Evgenia Polushkina ◽

Roman G. Shmakov

Keyword(s):

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Ethical Issues ◽

Complete Blood Count ◽

Treatment Approach ◽

Quantitative Polymerase Chain Reaction ◽

Chronic Phase ◽

Molecular Response ◽

Newly Diagnosed

Abstract Background Using oftyrosine kinase inhibitors (TKIs) in women with chronic myeloid leukemia (CML) at pregnancy is risky due to possible teratogenecity. Absence of TKIs for whole pregnancy is risky for remission loss and disease progression. Particular situations may warrant TKI usage at pregnancy for potential benefits despite potential risks although no precise indications have been developed. Rareness of cases and ethical issues make significant difficulties in decision making. Aim To develop and evaluate the treatment approach for CML and pregnancy considering leukemic burden and pregnancy terms. Materials and methods During years 2011-2015 we monitored prospectively 29 cases of pregnancy in 28 women with CML chronic phase developing the treatment scheme step by step (picture 1). In 16 cases molecular response (MR) at pregnancy start was the following: MR4 in 8 cases (BCR-ABL <0,01%), MR3 in 5 cases (BCR-ABL<0,1% and >0,01%), MR2 in 3 cases (BCR-ABL<1% and >0,01%). In 13 cases leukemic burden at pregnancy start was high: 6 cases without complete hematologic remission (CHR) including 5 newly diagnosed, 7 cases with BCR-ABL>1% and CHR. All women insisted to keep pregnancy in spite of risks. We recommended 1) immediate discontinuation of TKIs if they were taken 2) monthly follow-up of complete blood count (CBC) and BCR-ABL level by reverse quantitative polymerase chain reaction (RQ-PCR) 3) careful evaluation for developmental defects 4)possibility of using TKIs in cases of high leukemic burden starting from 15th pregnancy week as comparatively safe late term when main organogenesis is completed and blood-placental barrier (BPB) exists knowing that TKIs have limited BPB crossing ability. High leukemic burden was considered BCR-ABL>1% as this level correlates with complete cytogenetic response (CCyR) absence and increased progression risk. The absence and/or loss of CHR was crucial to warrant TKIs. Alternative approaches including interferon, leukapheresis and staying without treatment were weighted in all cases. Dasatinib (DAS) was avoided due to multitargeted action, high fetal/maternal (F:M) concentrations and known possibility of hydrops fetalis. All patients were informed about possible risks at every stage of pregnancy. Results In 19 of 29 cases TKIs taken at conception were discontinued at 4th -10th week: imatinib (IM) in 17 and nilotinib (NIL) in 2. Evaluation for BCR-ABL level was done regularly but not monthly. Practically significant timepoints for BCR-ABL evaluation were pregnancy start, week 15th and pregnancy end. In 17 cases TKIs were reinitiated or started first: 4 newly diagnosed cases, 2 with CHR loss, 11 with BCR-ABL>1% (high level at pregnancy start or MR loss). The TKIs taken were IM in 14 cases (dose 400 mg), NIL in 3 (1-400 mg, 1-600 mg 1- 800mg). In 1 woman NIL was taken from week 10th due to CHR loss and resistance to IM. In 12 other cases no TKIs were reinitiated at pregnancy as 11 had BCR-ABL<1% till pregnancy end and for 1 newly diagnosed at 35th week CML woman treatment was postponed till delivery. In 24 cases TKIs were continued after delivery. Five women with MR3-MR4 at pregnancy end prolonged off-treatment period for breastfeeding being on regular PCR control. All 5 newly diagnosed women got an optimal response on IM. In 3 woman switch from IM to TKI2 was needed after delivery. The 29 pregnancy outcomes were: 27 deliveries (1 woman twice), 1 spontaneous abortion on week 5th (IM stopped from week 4th), 1 non-developing pregnancy terminated at week 20th (IM at conception, intrauterine infection, normal fetus). All newborns had no birth defects. Eight children were born preterm (weeks 31-37), 7 of them had been exposed to TKIs after week 15th. Further development was without deviations, median follow-up 23 months (range 1 -52), including 17 children exposed to TKIs at late terms. In 5 cases the F:M concentration ratio was studied for IM and NIL ranging from 0,12 to 0,3. Conclusion Treatment approach considering leukemic burden and pregnancy terms may help to avoid treatment interventions in favorable situations and warrantinterests of both mother and child when treatment initiation is necessary.This approach can expand chances for woman with CML to have children. Possible risks should be understood by patient and physician. Management of CML at pregnancy in case of huge leukemic mass remains a complicated task, pregnancy in CML should be safely planned at deep remission. Figure 1. Figure 1. Disclosures Chelysheva: Bristol Myers Squibb: Honoraria; Novartis Pharma: Consultancy, Honoraria. Turkina:Bristol Myers Squibb: Consultancy; Pfizer: Consultancy; Novartis Pharma: Consultancy.

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