Chronic Myeloid Leukemia (CML)

Chronic myeloid leukemia is a myeloproliferative disease characterized by excess granulopoiesis (mature and immature granulocytes). Early: cells retain differentiation capacity; marrow function normal. Stable for years, then transforms to higher-grade malignancy. Age 30-40; <20 rare.

Common Symptoms

Maculopapular rash; lymph-node enlargement; hepatosplenomegaly; fever; cafe-au-lait spots; fatigue; hepatomegaly

Causes and Pathogenesis

(1) Etiology: ionizing radiation (Hiroshima/Nagasaki/ankylosing spondylitis/cervical cancer radiotherapy); benzene/chemotherapy; HLA-CW3/CW4 susceptibility. Familial clustering rare; no Ph chromosome in parents/children → acquired. (2) Mechanism: (a) Hematopoietic-stem-cell origin: chronic-phase erythroid/neutrophil/eosinophil/basophil/monocyte/platelet elevation; Ph chromosome in all lineages; G6PD heterozygote females show single isoenzyme; consistent chr9/22 abnormalities; consistent breakpoints within patient; X-linked polymorphism confirms monoclonality. (b) Progenitor-cell dysfunction: low mitotic index, long cell cycle, long mature granulocyte half-life; only 20% in S-phase (normal 40%); peripheral blood CFU-GM/BFU-E up to 100x normal; long-term culture yields Ph-negative progenitors (adhesion defect). (c) Molecular pathology: 1960 Nowell & Hungerford describe Ph chromosome (first non-random cancer-associated abnormality). 1973 Rowley shows t(9;22)(q34;q11). 1982 ABL cloned at 9q34; 1983 BCR-ABL fusion. c-abl (230kb, 11 exons, 1a/1b, 145kD non-receptor tyrosine kinase, SH2/SH3, C-terminal DNA/cytoskeleton binding). BCR (22q11, 130kb, 21 exons, 160kD, serine/threonine kinase). BCR-ABL fusion: M-bcr → p210 (b2a2/b3a2/b2a3); m-bcr → p190 (e1a2); u-bcr → p230 (e19a2). Mouse models confirm leukemogenesis. BCR-ABL cytoplasmic tyrosine kinase activates Ras signaling; beta1-integrin adhesion defect releases immature cells. Anti-apoptosis (bcl-2 upregulation). Blast crisis: +8, +Ph, i(17), +19, +21, -Y; myeloid transformation 80%, lymphoid 30%; p53 mutation in 20-30% myeloid transformation; p16 deletion in lymphoid transformation.

Treatment

Drug, supportive therapy

Preventive Measures

Diet: (Recommended) (1) Splenomegaly: adzuki beans/plums/jujubes/seaweed/turtle. (2) Bleeding: lotus root/grapes/shepherd's-paw/mushrooms/black fungus. (3) Anemia: pork liver/yellow croaker/sea cucumber/sesame/royal jelly. (4) Anti-leukemia: toads/alfalfa/garlic/wheat/carrot/walnut/dandelion/oysters. (5) Fever: fermented soybeans/scallion/mushrooms/mung bean/bitter melon. (6) Node enlargement: taro/chestnuts/mulberry/walnut/litchi/water chestnut/oysters. (Avoid) (1) Coffee/strong tea. (2) Mutton/dog meat/leek/pepper. (3) Rooster/pig-face. (4) Pig trotters/chicken innards/carp/crucian carp. (5) Tobacco/alcohol. (6) Onion/garlic/ginger/cinnamon. (7) Fatty/fried/moldy/pickled food.

Department to Visit

It is recommended to visit the Hematology department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.