DR Medhat MRCP

• Diagnosis:
Philadelphia is confirmatory.
Peripheral blood film :
- Leukocytosis (granulocytes) in all stages of differentiation within the myeloid
linage.
- Basophilia is important diagnostic marker especially when Philadelphia is
هام جدا absent.
- Monocytopenia
Neutrophil alkaline phosphatase. (differentiate it from leukemoid reaction)
Bone-marrow hypercellularity with
myloid-erythroid ratio.
Granulocytes at different stages of
diferentiation
- DD of BM failure with a large number of circulating myeloid series’ cells :
1) Chronic myelogenous leukaemia (CML) or
2) Myelofibrosis
- The C/P and routine investigations are often the same in both conditions.
- The diagnosis of myelofibrosis needs a trephine biopsy as the aspirate is often ‘dry’.
• Management :
1) Imatinib : Now is the 1 st line treatment (mechanism : inhibitor of tyrosine kinase)
2) Hydroxyurea (also used in PRV, painful attacks in sicklers and as antiretroviral in HIV)
3) Interferon- α.
4) Allogenic bone marrow transplant
Philadelphia translocation, t(9:22)
Good prognosis in CML.
Poor prognosis in AML & ALL.
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