Chronic Myelogenous Leukemia Differential Diagnoses
- Author: Emmanuel C Besa, MD; Chief Editor: Koyamangalath Krishnan, MD, FRCP, FACP more...
Diagnostic Considerations
Problems to be considered include the following:
- Acute myeloid leukemia
- Chronic myelomonocytic leukemia
- Chronic neutrophilic leukemia
- Thrombocythemia
- Leukemoid reactions from infections (chronic granulomatous [eg, tuberculosis])
- Tumor necrosis
Differential Diagnoses
- Agnogenic Myeloid Metaplasia With Myelofibrosis
- Essential Thrombocytosis
- Myelodysplastic Syndrome
- Myeloproliferative Disease
- Polycythemia Vera
Sawyers CL. Chronic myeloid leukemia. N Engl J Med. Apr 29 1999;340(17):1330-40. [Medline].
Druker BJ, Sawyers CL, Kantarjian H, et al. Activity of a specific inhibitor of the BCR-ABL tyrosine kinase in the blast crisis of chronic myeloid leukemia and acute lymphoblastic leukemia with the Philadelphia chromosome. N Engl J Med. Apr 5 2001;344(14):1038-42. [Medline]. [Full Text].
Kantarjian H, Sawyers C, Hochhaus A, et al, for the International STI571 CML Study Group. Hematologic and cytogenetic responses to imatinib mesylate in chronic myelogenous leukemia. N Engl J Med. Feb 28 2002;346(9):645-52. [Medline]. [Full Text].
Merx K, Muller MC, Kreil S, et al. Early reduction of BCR-ABL mRNA transcript levels predicts cytogenetic response in chronic phase CML patients treated with imatinib after failure of interferon alpha. Leukemia. Sep 2002;16(9):1579-83. [Medline]. [Full Text].
Talpaz M, Silver RT, Druker BJ, et al. Imatinib induces durable hematologic and cytogenetic responses in patients with accelerated phase chronic myeloid leukemia: results of a phase 2 study. Blood. Mar 15 2002;99(6):1928-37. [Medline]. [Full Text].
Kantarjian HM, Cortes JE, O'Brien S, et al. Imatinib mesylate therapy in newly diagnosed patients with Philadelphia chromosome-positive chronic myelogenous leukemia: high incidence of early complete and major cytogenetic responses. Blood. Jan 1 2003;101(1):97-100. [Medline]. [Full Text].
Kantarjian HM, Talpaz M. Chronic myelogenous leukemia. Hematol Oncol Clin N Am. Jun 2004;18(3):XV-XVI.
Shah NP, Tran C, Lee FY, et al. Overriding imatinib resistance with a novel ABL kinase inhibitor. Science. Jul 16 2004;305(5682):399-401. [Medline].
Volpe G, Panuzzo C, Ulisciani S, Cilloni D. Imatinib resistance in CML. Cancer Lett. Feb 8 2009;274(1):1-9. [Medline].
Faderl S, Talpaz M, Estrov Z, O'Brien S, Kurzrock R, Kantarjian HM. The biology of chronic myeloid leukemia. N Engl J Med. Jul 15 1999;341(3):164-72. [Medline].
Gambacorti-Passerini C, Antolini L, Mahon FX, Guilhot F, Deininger M al et. Multicenter independent assessment of outcomes in chronic myeloid leukemia patients treated with imatinib. J Natl Cancer Inst. Apr 6 2011;103(7):553-61. [Medline].
Druker BJ, Talpaz M, Resta DJ, et al. Efficacy and safety of a specific inhibitor of the BCR-ABL tyrosine kinase in chronic myeloid leukemia. N Engl J Med. Apr 5 2001;344(14):1031-7. [Medline]. [Full Text].
Goldman JM, Druker BJ. Chronic myeloid leukemia: current treatment options. Blood. Oct 1 2001;98(7):2039-42. [Medline]. [Full Text].
Santos FP, Alvarado Y, Kantarjian H, Verma D, O'Brien S, Mattiuzzi G, et al. Long-term prognostic impact of the use of erythropoietic-stimulating agents in patients with chronic myeloid leukemia in chronic phase treated with imatinib. Cancer. Mar 1 2011;117(5):982-91. [Medline].
Sawyers CL, Hochhaus A, Feldman E, et al. Imatinib induces hematologic and cytogenetic responses in patients with chronic myelogenous leukemia in myeloid blast crisis: results of a phase II study. Blood. May 15 2002;99(10):3530-9. [Medline].
Tang M, Gonen M, Quintas-Cardama A, et al. Dynamics of chronic myeloid leukemia response to long-term targeted therapy reveal treatment effects on leukemic stem cells. Blood. Aug 11 2011;118(6):1622-31. [Medline].
Ibrahim AR, Eliasson L, Apperley JF, Milojkovic D, Bua M, Szydlo R, et al. Poor adherence is the main reason for loss of CCyR and imatinib failure for chronic myeloid leukemia patients on long-term therapy. Blood. Apr 7 2011;117(14):3733-6. [Medline].
Hochhaus A, Kreil S, Corbin AS, La Rosée P, Müller MC, Lahaye T, et al. Molecular and chromosomal mechanisms of resistance to imatinib (STI571) therapy. Leukemia. Nov 2002;16(11):2190-6. [Medline].
Marcolino MS, Boersma E, Clementino NC, et al. Imatinib treatment duration is related to decreased estimated glomerular filtration rate in chronic myeloid leukemia patients. Ann Oncol. Sep 2011;22(9):2073-9. [Medline].
FDA Approval for Dasatinib. National Cancer Institute. Available at http://www.cancer.gov/cancertopics/druginfo/fda-dasatinib. Accessed August 24, 2011.
FDA Approval for Nilotinib. National Cancer Institute. Available at http://www.cancer.gov/cancertopics/druginfo/fda-nilotinib. Accessed August 24, 2011.
[Best Evidence] Cortes JE, Jones D, O'Brien S, Jabbour E, Ravandi F, Koller C, et al. Results of dasatinib therapy in patients with early chronic-phase chronic myeloid leukemia. J Clin Oncol. Jan 20 2010;28(3):398-404. [Medline]. [Full Text].
Kantarjian H, Shah NP, Hochhaus A, Cortes J, Shah S, Ayala M, et al. Dasatinib versus imatinib in newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med. Jun 17 2010;362(24):2260-70. [Medline].
Saglio G, Kim DW, Issaragrisil S, le Coutre P, Etienne G, Lobo C, et al. Nilotinib versus imatinib for newly diagnosed chronic myeloid leukemia. N Engl J Med. Jun 17 2010;362(24):2251-9. [Medline].
Kantarjian HM, Hochhaus A, Saglio G, et al. Nilotinib versus imatinib for the treatment of patients with newly diagnosed chronic phase, Philadelphia chromosome-positive, chronic myeloid leukaemia: 24-month minimum follow-up of the phase 3 randomised ENESTnd trial. Lancet Oncol. Sep 2011;12(9):841-51. [Medline].
Jabbour E, Kantarjian H, O'Brien S, et al. The achievement of an early complete cytogenetic response is a major determinant for outcome in patients with early chronic phase chronic myeloid leukemia treated with tyrosine kinase inhibitors. Blood. Oct 27 2011;118(17):4541-6; quiz 4759. [Medline].
Hughes TP, Hochhaus A, Branford S, Müller MC, Kaeda JS, Foroni L, et al. Long-term prognostic significance of early molecular response to imatinib in newly diagnosed chronic myeloid leukemia: an analysis from the International Randomized Study of Interferon and STI571 (IRIS). Blood. Nov 11 2010;116(19):3758-65. [Medline].
FDA. Sprycel (dasatinib): Drug Safety Communication – Risk of Pulmonary Arterial Hypertension. US Food and Drug Administration. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm275176.htm. Accessed October 11, 2011.
Sawyers CL. Even better kinase inhibitors for chronic myeloid leukemia. N Engl J Med. Jun 17 2010;362(24):2314-5. [Medline].
Jabbour E, Kantarjian H, O'Brien S, Shan J, Garcia-Manero G, Wierda W, et al. Predictive factors for outcome and response in patients treated with second generation tyrosine kinase inhibitors for chronic myeloid leukemia in chronic phase post imatinib failure. Blood. Oct 28 2010;[Medline].
Verma D, Kantarjian H, Strom SS, et al. Malignancies occurring during therapy with tyrosine kinase inhibitors (TKIs) for chronic myeloid leukemia (CML) and other hematologic malignancies. Blood. Oct 20 2011;118(16):4353-8. [Medline].
Simonsson B, Gedde-Dahl T, Markevarn B, et al. Combination of pegylated IFN-a2b with imatinib increases molecular response rates in patients with low- or intermediate-risk chronic myeloid leukemia. Blood. Sep 22 2011;118(12):3228-35. [Medline].
Moreb J, Johnson T, Kubilis P, Myers L, Oblon D, Miller A, et al. Improved survival of patients with chronic myelogenous leukemia undergoing allogeneic bone marrow transplantation. Am J Hematol. Dec 1995;50(4):304-6. [Medline].
McGlave PB, Beatty P, Ash R, Hows JM. Therapy for chronic myelogenous leukemia with unrelated donor bone marrow transplantation: results in 102 cases. Blood. Apr 15 1990;75(8):1728-32. [Medline].
Deininger M, Schleuning M, Greinix H, Sayer HG, Fischer T, Martinez J, et al. The effect of prior exposure to imatinib on transplant-related mortality. Haematologica. Apr 2006;91(4):452-9. [Medline].
Lima L, Bernal-Mizrachi L, Saxe D, Mann KP, Tighiouart M, Arellano M, et al. Peripheral blood monitoring of chronic myeloid leukemia during treatment with imatinib, second-line agents, and beyond. Cancer. Mar 15 2011;117(6):1245-52. [Medline].

