II. Epidemiology

  1. Chronic Leukemia is primarily an adult chronic cancer (esp. over age 65 years)

IV. Symptoms

  1. Asymptomatic at presentation (incidentally diagnosed based on CBC with Leukocytosis)
    1. Chronic Lymphocytic Leukemia
      1. Asymptomatic at diagnosis: 50%
    2. Chronic Myelogenous Leukemia
      1. Asymptomatic at diagnosis: 20%
  2. Symptomatic Patients
    1. Symptoms are much less common in Chronic Leukemia than with Acute Leukemia)
      1. Chronic Lymphocytic Leukemia: 15%
      2. Chronic Myelogenous Leukemia: 30%
    2. Constitutional symptoms
      1. Fever
      2. Fatigue
      3. Unintentional Weight Loss
      4. Night Sweats

V. Signs

  1. Splenomegaly (46 to 76% of CML cases)
    1. May be associated with early satiety, Anemia, Platelet abnormalities
  2. Hepatomegaly (CLL or CML)
  3. Lymphadenopathy (CLL or CML)

VI. Labs

  1. Complete Blood Count (both CLL and CML)
    1. Leukocytosis (or Hyperleukocytosis)
      1. White Blood Cell Count is >20,000/mm3 in most cases, and often >100,000/mm3 (Hyperleukocytosis)
      2. Contrast with normal white cell counts or Leukopenia associated with Acute Leukemias
  2. Chronic Lymphocytic Leukemia (CLL)
    1. Significant increase of normal appearing Lymphocytes (>50% of cells)
    2. Peripheral blood for clonal expansion of B Lymphocytes >5000/mm3, and confirmed by flow cytometry
    3. Bone Marrow Biopsy is not needed for diagnosis (but defines extent of marrow involvement related to prognosis)
  3. Chronic Myelogenous Leukemia (CML)
    1. Peripheral Smear with few blast cells and increased Basophils and Eosinophils
    2. Philadelphia Chromosome (BCR-ABL1 Fusion Gene) on peripheral blood or Bone Marrow testing
      1. Present in 90 to 95% of CML cases
      2. Also present in ALL (2-4% of children, 20-40% of adults)

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