Leukemia Chronic Myelogenous Diagnosis

Chronic myelogenous leukemia (CML), also known as chronic myeloid leukemia, is a cancer of the blood and bone marrow. CML leukemia typically produces few symptoms in its early phases, which means it’s often not diagnosed until later, advanced stages.

Physical Tests for CML Leukemia

Chronic myelogenous leukemia’s lack of early symptoms limits the effectiveness of routine physical exams as diagnostic tools. Doctors may, however, notice symptoms during a physical exam to check overall health. An enlarged spleen sometimes occurs due to CML and may be detected during a physical exam. Doctors may also note symptoms such as fatigue, night sweats or lost appetite, which can be signs of CML.

Blood Tests and Chronic Myeloid Leukemia

Abnormal results on routine blood tests are often the first indication of chronic myelogenous leukemia. Diagnostic tests for CML include a complete blood count, or CBC.

A CBC provides information on blood composition, including the number of red and white blood cells, platelet counts, and the amount of hemoglobin in the blood. A person with chronic myeloid leukemia has elevated levels of white blood cells. The blood test may also reveal anemia or abnormalities in platelet counts.

Abnormal CBC results indicate the need for further testing, but cannot be used to definitively diagnose CML.

Leukemia and Bone Marrow Aspiration

Doctors may require a bone marrow aspiration during CML diagnosis. During a bone marrow aspiration, a long, thin needle is inserted into either the pelvic or breastbone to retrieve a sample of bone marrow. Bone marrow aspirations take place in hospitals or doctor’s offices under local anesthetic.

The sample of bone marrow is closely examined for abnormal cells. A bone marrow aspiration may be required to rule out conditions other than chronic myeloid leukemia.

Cytogenetic Analysis and CML Diagnosis

Cytogenetic analysis examines either blood or bone marrow for chromosomal abnormalities.

Unlike other types of leukemia, CML is associated with a specific chromosomal abnormality known as the Philadelphia chromosome. The Philadelphia chromosome occurs in the majority of chronic myelogenous leukemia cases.

Diagnostic Difficulties and CML Leukemia

While the presence of the Philadelphia chromosome indicates a high likelihood of chronic myelogenous leukemia, it is sometimes present in people with other conditions, such as acute lymphocytic leukemia and nonlymphocytic leukemia. Further testing may be necessary to rule out other forms of leukemia.

The accelerated and blast phases of chronic myeloid leukemia can resemble acute myelogenous leukemia. Chronic myelogenous leukemia must also be differentiated from other diseases of the bone marrow and blood.

Once doctors confirm a diagnosis of CML, leukemia is classified according to phases. Chronic myeloid leukemia is classified in three phases: the chronic stage, the accelerated stage, and the blast stage. The first stage can last for years, and responds the best to treatment, particularly with the targeted drug imatinib. Once the disease enters the accelerated stage, more aggressive treatment is required.

Resources

Besa, E.; Woermann, U. (2010). Chronic myelogenous leukemia: Differential diagnoses and workup. Retrieved September 23, 2010, from http://emedicine.medscape.com/article/199425-diagnosis.

Mayo Clinic. (2008). Chronic myelogenous leukemia. Retrieved September 23, 2010, from http://www.mayoclinic.com/health/chronic-myelogenous-leukemia/DS00564.

Merck Manuals Online Medical Library. (2008). Chronic myelocytic leukemia (CML). Retrieved September 23, 2010, from http://www.merck.com/mmhe/sec14/ch176/ch176e.html?qt=chronic myeloid leukemia