Chronic myeloid leukemia (CML) is a myeloproliferative disorder that is characterized by increased production of the granulocytic cell line without loss of the ability to differentiate. CML accounts for 10% to 15% of all leukemias. CML is uncommon before 20 years of age, but the incidence increases with age (mean age is 65 years). CML has three stages: (1) chronic, (2) transformation, and (3) accelerated or blast crisis.
CML arises from a mutation in the myeloid stem cells. Normal myeloid cells continue to be produced, but there is a pathologic increase in the production of forms of blast cells. Marrow expands into cavities of the long bones, and cells are formed in the liver and spleen, with resultant painful enlargement problems. A cytogenetic abnormality termed the Philadelphia chromosome is found in 90% to 95% of patients. Patients diagnosed with CML in the chronic phase have few symptoms and complications, with an overall median life expectancy well exceeding 5 years. The transformation phase can be insidious or rapid; it marks the process of evolution (or transformation) to the acute form of leukemia (blast crisis). If the disease transforms to the acute phase (blast crisis), the disease becomes more difficult to treat. Infection and bleeding are rare until the disease transforms to the acute phase.
Nursing management is similar to that for CLL. See “Nursing Process” under “Leukemia” for additional information.
For more information, see Chapter 34 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.