CML EXAM EVALUATION QUESTIONS AND SOLUTIONS
2025/2026 ALL GRADED A+
✔✔Bcr-Abl Tyrosine Kinase Activity - ✔✔Fluorescence In Situ Hybridization
Used before treatment, after treatment we need pcr
BCR-ABL Downstream Picture
Only focus on top piece which is the tyrosine kinase Phosphorylates itself don't know
which pathways are activated
Myeloid Leukemia.
✔✔Initial Work Up - ✔✔Always want to get a bone marrow biopsy and palpate the
spleen
H & P, including spleen size by palpation (in cm below the costal margin)
CBC with differential
CMP
HLA testing (if bone marrow transplant considered)
Bone marrow aspirate & biopsy
Morphologic review
Percent blasts
Percent basophils
Cytogenetics; obtain karyotype
FISH
Quantitative PCR using International scale
For philidelphia chromosome - cytogenetics, FISH gets results back faster PCR
baseline disease
✔✔Risk Stratification/Prognosis - ✔✔Sokal Score (developed in busulfan era)
Age
, Blast Count in peripheral blood
Platelet count
Spleen size
Large Spleen
Spleen gets bigger due to filling up with WBCs, it also houses platelets, and because
liver and spleen make more blood cells,
Bone marrow is not the only source for producing RBCs
Low, Intermediate, High risk categories
✔✔Chronic Phase - ✔✔Most CML patients diagnosed while in this phase (90%) from
abnormal CBC
Only 1⁄2 have symptoms at diagnosis
CML cells can still function if mature
Infection/bleeding complications rare
<10% blasts in peripheral blood & bone marrow
Symptoms:
Fatigue
Abdominal fullness or pain
Goal:
↓ WBC,
↑ in Hb,
Resolution of symptoms,
Cure??
Most patients produce in chronic phase, usually asymptomatic, and High WBCs
✔✔Chronic Phase Symptoms - ✔✔Fatigue
Abdominal fullness or pain
✔✔Chronic Phase Goal - ✔✔Fatigue
Abdominal fullness or pain
↓ WBC,
↑ in Hb,
Resolution of symptoms,
Cure??
✔✔Accelerated Phase Overview - ✔✔WBC may ↓ to or ↑ due to accumulation of blast
cells
15-29% blasts in bone marrow
Persistent thrombocytopenia (<100K cells/μL)
Peripheral blood basophilia > 20%
Cytogenetic Evolution with loss of response to trt
Progressive splenomegaly
Goal:
Return to chronic phase
2025/2026 ALL GRADED A+
✔✔Bcr-Abl Tyrosine Kinase Activity - ✔✔Fluorescence In Situ Hybridization
Used before treatment, after treatment we need pcr
BCR-ABL Downstream Picture
Only focus on top piece which is the tyrosine kinase Phosphorylates itself don't know
which pathways are activated
Myeloid Leukemia.
✔✔Initial Work Up - ✔✔Always want to get a bone marrow biopsy and palpate the
spleen
H & P, including spleen size by palpation (in cm below the costal margin)
CBC with differential
CMP
HLA testing (if bone marrow transplant considered)
Bone marrow aspirate & biopsy
Morphologic review
Percent blasts
Percent basophils
Cytogenetics; obtain karyotype
FISH
Quantitative PCR using International scale
For philidelphia chromosome - cytogenetics, FISH gets results back faster PCR
baseline disease
✔✔Risk Stratification/Prognosis - ✔✔Sokal Score (developed in busulfan era)
Age
, Blast Count in peripheral blood
Platelet count
Spleen size
Large Spleen
Spleen gets bigger due to filling up with WBCs, it also houses platelets, and because
liver and spleen make more blood cells,
Bone marrow is not the only source for producing RBCs
Low, Intermediate, High risk categories
✔✔Chronic Phase - ✔✔Most CML patients diagnosed while in this phase (90%) from
abnormal CBC
Only 1⁄2 have symptoms at diagnosis
CML cells can still function if mature
Infection/bleeding complications rare
<10% blasts in peripheral blood & bone marrow
Symptoms:
Fatigue
Abdominal fullness or pain
Goal:
↓ WBC,
↑ in Hb,
Resolution of symptoms,
Cure??
Most patients produce in chronic phase, usually asymptomatic, and High WBCs
✔✔Chronic Phase Symptoms - ✔✔Fatigue
Abdominal fullness or pain
✔✔Chronic Phase Goal - ✔✔Fatigue
Abdominal fullness or pain
↓ WBC,
↑ in Hb,
Resolution of symptoms,
Cure??
✔✔Accelerated Phase Overview - ✔✔WBC may ↓ to or ↑ due to accumulation of blast
cells
15-29% blasts in bone marrow
Persistent thrombocytopenia (<100K cells/μL)
Peripheral blood basophilia > 20%
Cytogenetic Evolution with loss of response to trt
Progressive splenomegaly
Goal:
Return to chronic phase
