factors affecting survival in chronic myeloid leukemia patients

Abstract

Chronic myeloid Leukemia is categorised into Chronic Phase(CP), Accelerated Phase(AP) and Blast Crisis(BC). Poor prognostic factors for survival include the presence of splenomegaly, hepatomegaly, older age, leukocytosis, increased blast counts and expansion of paratrabecular seams of myeloblasts, increased basophil counts, thrombocytopenia, or thrombocytosis and cytogenetic clonal evolution. We have made an attempt to find out the factors affecting survival of chronic myeloid leukemia patients. Materials and Methods: Present study was carried out on forty-six patients (30 males and 16 females) of CML. Staining of peripheral smears was done with Leishman’s stain. Cytochemistry of peripheral smears was carried out with Leukocyte Alkaline Phosphatase (LAP) in thirteen cases. Staining for myeloperoxidase, Sudan Black and PAS reaction was done in cases of CML with blast crisis. Bone marrow aspiration and biopsy was also done in 33 cases. Observations: Out of 46 cases; 89% of cases were in CP, 7% in AP and 4% in BC and 3 cases of CML-chronic case were of adult type of juvenile CML. 90% of patients of CML-CP and 100% in CML-AP and CML-BC were anaemic . All of them had increased leukocytosis. Platelet count in CML-CP was decreased in 7% of cases, normal in 49% of cases and increased in 12%.Haemoglobin, total leukocyte count and platelet counts were lower in cases of accelerated phase and blast crisis phase as compared to those in chronic phase. Conclusion: Eleven out of thirteen patients had low LAP score. All the patients who progressed to higher grade leukaemia had spleen size > 10 cm at presentation. Patients who had high LAP scores, died. Two patients who had grade-III fibrosis progressed to blast crisis and one patient who progressed to accelerated phase had grade-II fibrosis. 29% CML-G patients progressed to blast crisis and 4% of CML-GM progressed to accelerated phase.