Clinical features

In a majority of patients CML is diagnosed when they are in the chronic phase (CP) which is asymptomatic for prolonged periods (1).

Symptoms appear when there is expansion of CML cells (2). The clinical features of CML may be classified into:

• non-specific systemic features:
  • anaemia
  • malaise & fatigue
  • weight loss
  • sweating
• common features:
  • bleeding diathesis:
    • discrete ecchymoses
    • menorrhagia
  • splenomegaly
• hepatomegaly
• rare features:
  • abdominal pain or pleuritic pain due to splenic infarction
  • gout
  • signs and symptoms of hyperviscosity due to leukocytosis - retinal haemorrhages, priapism, cerebrovascular accidents, tinnitus (2)
  • fever

Signs and symptoms which indicate a progressive disease (from chronic phase through accelerated phase to blastic phase) include:

• progressive leukocytosis
• thrombocytosis or thrombocytopenia
• anemia
• increasing and painful splenomegaly or hepatomegaly
• fever
• bone pain
• development of destructive bone lesions.
• thrombotic or bleeding complications (3).

Reference:

• (1) Heaney NB, Holyoake TL. Therapeutic targets in chronic myeloid leukaemia. Hematol Oncol. 2007;25(2):66-75.
• (2) Quintás-Cardama A, Cortes JE. Chronic myeloid leukemia: diagnosis and treatment. Mayo Clin Proc. 2006;81(7):973-88.
• (3) National Cancer Institute at the National Institutes of Health. Chronic Myelogenous Leukemia Treatment