Clinico-Hematological Profile in Patients with Chronic Myeloid Leukemia

Abstract

Background: Chronic myeloid leukemia (CML) is a clonal malignant neoplasms of pluripotent hematopoietic stem cell described by the excessive proliferation of mature granulocytes and their precursors in the bone marrow and peripheral blood. It is characterized by the presence of Philadelphia chromosome, a translocation between chromosome 9 and 22 or BCR-ABL1 gene. Objectives: To evaluate clinical and hematological parameters in patients with chronic myeloid leukemia and to assess the risk stratification of these patients according to Sokal and European Treatment Outcome Study (EUTOS) scoring systems. Setting: This case series study conducted at Ibn-Sina Teaching Hospital/Outpatients Hematology Department from November 2019 to April 2020. Patients and methods: Total seventy patients with chronic myeloid leukemia included in this study. They involved 64 old cases and 6 new cases. The records of old cases were reviewed for clinical history, clinical examination, previous blood counts, bone marrow study and genetic study, where ever it was available. For new cases clinical history and physical examinations were noted. Complete blood pictures, biochemical tests and molecular study (BCR-ABL) were done at private laboratory. The BCR-ABL done by real-time reverse transcription polymerase chain reaction using Xpert BCR-ABL Ultra test on Cepheid GeneXpert® Dx System. All patients were categorized into different risk groups by using Sokal and European Treatment Outcome Study scores that calculated according to standard formulae. Results: The males were (57.1%) of patients and females were (42.9%) with male to female ratio was 1.33:1, their age ranged from 16-82 years with a mean of 41.9 years. The most common complains were fatigue (87.1%), fullness in the abdomen (78.6%) and constitutional symptoms (64.3-74.3%). About 96% of patients had splenomegaly at presentation. The mean total leucocyte count was 153.7 x10 9 /L, basophilia found in (72.9%) of patients and anemia in (85.7%) of them. By Sokal score, (25.7%) of patients were categorized as low risk, (52.8%) as intermediate risk and (21.4%) as high risk. According to EUTOS score, (60%) of patients were categorized as low risk, while (40%) of them as high risk. There were significant differences in high and low risk groups between two scoring systems (P-values 0.016, 0.000). Conclusion: Middle age groups (35-54 years) were commonly affected by chronic myeloid leukemia and males were predominance over females. Fatigue, fullness in the abdomen were the most common complains, while splenomegaly was the most common clinical sign. Majority of the patients, when categorized by the Sokal score, fall under the lowand intermediate-risk groups, the same is true for the EUTOS score, which, however, does not have an intermediate risk category.