by Nicole Evans M.D.

Created on: August 24, 2009   Last Updated: December 15, 2010

Common chronic leukemias include chronic myeloid leukemia, and chronic lymphocytic leukemia. Chronic myeloid leukemia is also known as chronic myelogenous leukemia or chronic granulocytic leukemia. Chronic lymphocytic leukemia may also be called chronic lymphoid leukemia or B-cell chronic lymphocytic leukemia.

CML:

Chronic myeloid leukemia (CML) is a clonal disorder. The stem cell that has transformed to the cancerous "leukemic" version gives rise to every type of cell that normally starts in the bone marrow: red cells, neutrophils, eosinophils, basophils, monocytes, platelets, T cells and B cells.

CML has three different phases. The chronic phase occurs when the white blood cell counts increase and the spleen and liver enlarge.

The accelerated phase of chronic myelogenous leukemia occurs when the red blood cells and platelets decrease. Symptoms during the accelerated phase include bone pain, fever, night sweats and weight loss.

The last phase is called the blastic phase. The blastic phase of chronic myeloid leukemia occurs when the peripheral blood and bone marrow are filled with rapidly proliferating leukemic blast cells.

CML is diagnosed when the peripheral blood shows increased myeloblasts, basophils, and white blood cells. The leukocyte alkaline phosphatase is low in CML cells as well.

Approximately, 90% of individuals with CML will have a genetic translocation of 9 and 22, known as the Philadelphia chromosome. This may help confirm the diagnosis of CML and guide prognosis.

Treatment of CML involves an allogenic bone marrow transplant for younger patients. Other patients generally receive chemotherapy that includes busulfan and hydroxyurea in the chronic phase and vincristine with prednisone in the accelerated or blastic phase.

CLL:

Chronic lymphocytic leukemia (CLL) is a clonal disorder of mature lymphocytes. It can disrupt normal bone marrow production of cells. However, it predominately affects the B cells, causing an impairment of humoral immunity.

CLL often presents with lymphadenopathy (swollen lymph nodes) and splenomegaly (enlarged spleen). Because of the impaired humoral (B cell derived) immunity the patient is susceptible to recurrent and serious infections. The depressed humoral immunity causes neutropenia and hypogammaglobulinemia. At the later stages of chronic lymphoid leukemia symptoms such as fever, night sweats and weight loss may occur.

The diagnosis of CLL is often an incidental finding on a routine complete blood count showing lymphocytosis (elevated white blood cells). A lymph node biopsy may be done and can aid in the diagnosis of CLL.

Chronic lymphoid leukemia is treated with alkylating chemotherapeutic agents such as chlorambucil. Steroids may be used as well as cyclophosphamide, vincristine and/or doxorubicin. Immunoglobulin (IgG) may be given for hypogammaglobulinemia.

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