11/03/2026
Chronic Myeloid Leukemia (CML)
ITE/Board review only✨🧠
Memory mnemonic 🧠✨
1. Dasatinib ➡️ Diaphragm (Dripping Lungs): Avoid in patients with Pleural Effusions or CHF 🫁
2. Nilotinib ➡️ Narrowing (Nasty Vessels): Avoid in patients with Arterial Disease (PAD/Stroke) or Diabetes 🛣️
3. Bosutinib ➡️ Bowels (Bathroom): Avoid in patients with IBD or severe GI issues (causes massive Diarrhea) 🚽
4. Ponatinib ➡️ Pipe-Plugger (Potent): Used for the T315I "Gatekeeper" mutation, but causes Vascular Plugs (Thrombosis) 🚫🩸
1. Pathobiology and Genetics 🧬
->CML is a myeloproliferative neoplasm characterized by the Philadelphia (Ph) chromosome, a (9;22)(q34;q11) translocation.
->The Fusion: Fuses BCR (Chr 22) with ABL1 (Chr 9) 🤝.
->The Result: A constitutively active tyrosine kinase that drives myeloid proliferation 📈.
->Common Transcripts: Most express p210 (e13a2 or e14a2).
->Note: e14a2 is the most common and linked to better molecular responses 🌟.
->Atypical Transcripts (~2–3%): Standard PCR might miss these! If Ph+ but PCR negative, suspect an atypical transcript and use FISH 🎣.
2. Diagnostic Workup & Staging 🏥
Peripheral blood PCR is great, but bone marrow aspirate/biopsy is still the "gold standard" for diagnosis 🦴.
Baseline Evaluation 📋
Morphology: Check blast % and basophils to find the disease phase 🔍.
Cytogenetics (Karyotype): Essential to find the Ph chromosome and Additional Cytogenetic Abnormalities (ACAs) like trisomy 8 (+8) 🧬.
PCR (RT-qPCR): Establish the baseline level for future tracking 📉.
isk Scoring: Use Sokal or ELTS to pick your frontline TKI 🎯.
Disease Phases 🚦
PhaseDefinition (WHO/ICC)Chronic (CP) 🟢