Hematology Chronic Myeloid Leukemia (CML) | Quizlet

Which of the following translocations is seen in CML?

A) t(9;22)

B) t(8;21)

C) t(8;14)

D) t(11;14)

t(9;22)

Feedback

The translocation associated with CML is the t(9;22), referred to as the Philadelphia chromosome.

t (8;21) is associated with Acute Myeloid Leukemia (FAB M2).

t (8;14) is associated with Burkitt's Lymphoma.

t (11;14) is associated with Chronic Lymphoid Leukemia and multiple myeloma.

Which of the following can be helpful in differentiating CML from a leukemoid reaction?

CBC

WBC count

LAP

New Methylene Blue

LAP

Feedback

The LAP, which stands for Leukocyte Alkaline Phosphatase, is helpful in distinguishing CML from a leukemoid reaction. A leukemoid reaction will present with a high LAP score, while CML will have a low LAP score.

The results of the CBC from a person with CML and a person with a leukemoid reaction can look similar and is therefore, not the best answer.

The WBC on patients of both CML and leukemoid reactions can look similar and is not a good differentiator.

New Methylene Blue is a supravital stain commonly used to perform reticulocyte counts.

From the options provided below, select the correct characteristics of CML:

More than one answer is correct. Please select all correct answers

CML is characterized by leukopenia and thrombocytopenia

CML goes into phases: chronic, accelerated, and blastic

50% of patients with CML have positive Philadelphia chromosome t(9:22)

Untreated CML progresses to acute leukemia in 2-3 years

CML goes into phases: chronic, accelerated, and blastic

Untreated CML progresses to acute leukemia in 2-3 years

Feedback

CML progresses over the years to accelerated and blastic phases.

Patients with untreated CML can progress to accelerated and blastic phases in 2-3 years.

CML is characterized by leukocytosis and thrombocytosis, NOT by leukopenia and thrombocytopenia.

Greater than 95% of CML patients have the Philadelphia chromosome.

Which of the following are features of CML?

More than one answer is correct. Please select all correct answers

Fatigue, weight loss, night sweats, and left upper abdominal quadrant painMay be asymptomatic and only discovered by routine CBCCan be caused by repeated bacterial infectionsPatients with CML do not present with an enlarged spleen

Fatigue, weight loss, night sweats, and left upper abdominal quadrant pain

May be asymptomatic and only discovered by routine CBC

Feedback

CML has no known predisposing factors. Most patients with CML are diagnosed in the chronic phase. Patients in the chronic phase are presented with fatigue, weight loss, night sweat, and left upper quadrant pain due to large spleen. Few patients may be asymptomatic and discovered when routine blood count is abnormal. Progression to accelerated and/or blastic phase is accompanied by worsened performance, worsened anemia, thrombocytopenia, and progressive splenomegaly.

The chronic phase of CML shows blast proliferation in the skin, lymph nodes, central nervous system, and other organs.

True

False

False

Feedback

Extra-medullary blast proliferation is seen in the blastic phase, NOT in the chronic phase.

Patients with CML first present with leukopenia. As the disease progresses to the accelerated and blastic phases, the WBC count increases.

True

False

False

Feedback

FALSE. Leukocytosis and thrombocytosis is the hallmark of the chronic phase of CML.

Patients with CML:

Never progress to acute leukemia

Show disease progression in the skin, lymph nodes, brain, and lungs

Show spontaneous remission in 2-3 years

Are often misdiagnosed as a leukemoid reaction because it is difficult to distinguish CML from a leukemoid reaction

Show disease progression in the skin, lymph nodes, brain, and lungs

Feedback

Disease progression shows infiltration to other tissues such as the skin, lymph nodes, brain, and lungs.

Progression to acute leukemia is the natural course in untreated patients with CML.

Untreated cases show progression to accelerated and blastic phases in 2-3 years.

CML can be easily be distinguished from leukemoid reaction by examining the blood smear, bone marrow, cytogenetics, and leukocyte alkaline phosphatase stain.

In the chronic phase of CML, the blood smear shows all of the following, EXCEPT:

Leukocytosis and thrombocytosis

The WBC differential shows peak in the number of neutrophils and myelocytes

The blood smear shows increase in the number of eosinophils, and basophils

A high percentage of blasts in the peripheral blood and bone marrow (>19%)

A high percentage of blasts in the peripheral blood and bone marrow (>19%)

Feedback

Increases in the percentage of blasts are seen in the accelerated and blastic phases of CML.

High WBC and platelet counts are the initial features of CML.

The chronic phase of CML shows a WBC differential with a peak in the number of neutrophils and myelocytes.

Eosinophilia and basophilia are also seen in the chronic phase of CML.

In the blastic phase of CML, the peripheral blood and/or bone marrow show:

More than one answer is correct. Please select all correct answers

Greater than 19% blasts

Blast percentages between 10-19%

Blasts that are either myeloid, lymphoid, or mixed

Blasts only confined to the bone marrow, NOT the peripheral blood

Greater than 19% blasts

Blasts that are either myeloid, lymphoid, or mixed

Feedback

The blood or bone marrow blasts are >19% in patients that are in the blastic phase of CML. In 70% of CML blastic cases the blasts are myeloid in nature, while 20-30% of cases are lymphoid, and a small percentage are mixed.

In the blastic phase, the blood or bone marrow blasts exceed 19%. Most commonly the bone marrow appears to have more than 19% blasts with an increase in peripheral blood blasts. In some cases, the peripheral blood may have more than 19% blasts.

Extra-medullary blasts proliferation is seen the blastic phase.

One criteria of the accelerated phase of CML is that the bone marrow has more than 19% blasts.

True

False

False

Feedback

In the chronic phase of CML, the blasts in the blood or bone marrow range between 10-19%.