Correspondence

Chronic Myeloid Leukemia

N Engl J Med 1999; 341:765September 2, 1999

Article

To the Editor:

The definition of “chronic myeloid leukemia” (CML) in Sawyers's excellent review article (April 29 issue)1 describes the disease as “a malignant clonal disorder of hematopoietic stem cells that results in increases in not only myeloid cells but also erythroid cells and platelets in peripheral blood and marked myeloid hyperplasia in the bone marrow.” Although this definition accurately reflects the molecular and cellular pathophysiologic features of this condition, it is clinically misleading because patients with CML almost always present with an elevated granulocyte count, a variably increased platelet count (in 30 to 50 percent of patients), and anemia (in approximately 85 percent of patients). Only very, very rarely in CML is there erythrocytosis.2-5 Indeed, in Table 1 of Sawyers's review, the list of peripheral-blood findings appropriately does not include erythrocytosis. By counteracting the white cells' effect on blood viscosity, the anemia associated with CML may actually be of some benefit to patients with marked leukocytosis. Thus, the usual presentation of CML is different from that of polycythemia vera. In the latter, there is commonly erythrocytosis, leukocytosis, and thrombocytosis and often the clinical effects of blood hyperviscosity. Measurement of leukocyte alkaline phosphatase, chromosomal studies (for the Philadelphia chromosome), and use of molecular probes for the BCR–ABL translocation can help distinguish the two conditions when necessary.

Irwin Nash, M.D.
Hospital of Saint Raphael, New Haven, CT 06511

5 References

1. 1

   Sawyers CL. Chronic myeloid leukemia. N Engl J Med 1999;340:1330-1340
   Full Text | Web of Science | Medline

2. 2

   Lichtman MA. Chronic myelogenous leukemia and related disorders. In: Beutler E, Lichtman MA, Coller BS, Kipps TJ, eds. Williams' hematology. 5th ed. New York: McGraw-Hill, 1995:298-324.
   

3. 3

   Athens JW. Chronic myeloid leukemia. In: Lee GR, Bithell TC, Foerster J, Athens JW, Lukens JN, eds. Wintrobe's clinical hematology. 9th ed. Vol. 2. Philadelphia: Lea & Febiger, 1993:1969-98.
   

4. 4

   Glasser RM, Walker RI. Transitions among the myeloproliferative disorders. Ann Intern Med 1969;71:285-307
   Web of Science | Medline

5. 5

   Hoppin EC, Lewis JP. Polycythemia rubra vera progressing to Ph¹-positive chronic myelogenous leukemia. Ann Intern Med 1975;83:820-823
   Web of Science | Medline

Author/Editor Response

Dr. Sawyers replies:

To the Editor: I concur with Dr. Nash's comments and appreciate his clarification of this point.

Charles L. Sawyers, M.D.
University of California at Los Angeles, Los Angeles, CA 90095-1678

Citing Articles (2)

Citing Articles

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   Min Sik Kim, Dong Hyun Lee, Yu Rim Lee, Dong Kyun Kim, Suk Hyang Bae, Jin Yeon Hwang, Kyung A Kwon, Suee Lee, Jin Yeong Han, Ki Uk Kim, Sung-Hyun Kim. (2010) A case of subdural hematoma in patient with chronic myeloid leukemia treated with high-dose imatinib mesylate. The Korean Journal of Hematology 45:1, 73
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   Yanmin Zhao, Lizhen Liu, Yingjia Wang, Gongqiang Wu, Xiaoyu Lai, Weijie Cao, Yi Luo, Yamin Tan, Jimin Shi, Wanzhuo Xie, Xiujin Ye, Zhen Cai, Maofang Lin, He Huang. (2009) Efficacy and prognosis of chronic myeloid leukemia treated with imatinib mesylate in a Chinese population. International Journal of Hematology 89:4, 445-451
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