CML 2023

Chronic Myeloid Leukemia

CML

• Chronic phase/ Accelerated/ Blast
• Baseline : BCR-ABL % IS
• Sokal score:
• Eutos Score:

Presentation:

Date: WBC at presentation, spleen palpable below costal margin, total spleen size, symptoms, anemia or thrombocytopenia

Date	Timeline	IS %	Goal	BMBx/CBC
	Baseline		NA
	3 months		<10%
	6 months		<10%
	9 months		<1%
	12 months		<0.1% ( for TFR) otherwise < 1%

Pearls:

1.  30% of blast crisis in CML can be lymphoid rather than myeloid.

2. All the TKIs except nilotinib are FDA approved in blast crisis.

How to differentiate between CML blast crisis and de novo ph+ ALL?

FISH studies can detect the isoforms of BCR-ABL oncogene and provide important clues. The p210 isoform is commonly seen in CML, whereas the p190 isoform occurs in the majority of Ph + ALL .

 Flow cytometry  for CD 26+ which are seen on myeloid stem cells.

Dasatinib 100 mg CP, 140 mg daily AP

Monitor for hematologic and non hematologic toxicities which may require drug management including dose adjustment, briefly interrupting therapy, change of therapy and symptomatic management.

Non hematologic toxicities include: fluid retention, pleural and pericardial effusion, GI upset, rash.

Look for other causes of anemia and thrombocytopenia.

Rash: topical, systemic steroids

Hold for  hepatotoxicity at thresholds Bili 3 times, transaminases 5 times

Imatinib cramps: calcium, magnesium, L carinitine supplements

EKG, echo, diuretics for fluid overload