Haematology 7 - CML

Question 1

How does CML affect the liver and spleen?

Answer 1

Infarction of cords and red pulp (spleen) and hepatic sinusoids (liver) by granulocytes- causes hepatosplenomegaly, but no lymphadenopathy in CML

Question 2

Recall 3 possible symptoms of CML

Answer 2

Lethargy
Bruising
Monocular blindness (due to CVA)

Question 3

In what ways will a blood film be unusual in CML?

Answer 3

Myelocytes present
Raised basophils

Biphasic peak of neutrophils and myelocytes

Question 4

What investigation can be done to show BCR-ABL

Answer 4

FISH - a fluorescent DNA probe hybridises selectively to a particular chromosome segment

PCR (best to diagnose and determine response to therapy)

Question 5

What are the phases of CML?

Answer 5

Chronic: 3-4 years (<5% blasts in BM)
Accelerated: 6-12 months (5-19% blasts)
Blast crisis: 3-6 months (>20% blasts)

Question 6

What are the 1st, 2nd and 3rd line treatments for CML?

Answer 6

1st. Imatinib (1st gen Abl-TK inhibitor)
2nd. 2nd/3rd generation TK inhibitor
3rd. allogenic stem cell transplant