Paediatrics: Chronic Myeloid Leukaemia: Free MSRA Podcast

⚕️ FREE MSRA PODCAST – Chronic Myeloid Leukaemia (CML)🎧 A clear, high-yield breakdown of this blood cancer involving the Philadelphia chromosome – perfect for exam prep and real-life clinical scenarios.🧠 Key Learning Points📌 Definition• CML is a chronic myeloproliferative neoplasm characterised by uncontrolled proliferation of myeloid cells in the bone marrow, due to the Philadelphia chromosome.📌 Causes & Risk Factors• Caused by a specific translocation t(9;22) forming the BCR-ABL fusion gene• Risk increases with:– Age (typically diagnosed at median age 72)– Male gender– Prior radiation exposure (e.g., atomic bomb survivors)– Previous chemotherapy or radiotherapy– Smoking– Rare genetic predispositions💡 Mnemonic: AGGRIP – Age, Gender, Genetics, Radiation, Iatrogenic, Pollutants/Smoking📌 Pathophysiology• t(9;22) → BCR-ABL fusion gene → constitutively active tyrosine kinase• Causes uncontrolled proliferation of granulocytes (esp. neutrophils, eosinophils, basophils)• Accumulation of immature cells crowds out normal marrow function📌 Symptoms• Often asymptomatic in chronic phase• If symptomatic:– Fatigue– Night sweats– Weight loss– Splenomegaly (early satiety, LUQ pain)– Anemia-related symptoms– Easy bruising– Gout (↑ urate from cell turnover)💡 Mnemonic: F.N.W.S.A.G. – Fatigue, Night sweats, Weight loss, Splenomegaly, Anemia, Gout📌 Differential Diagnosis• Other myeloproliferative neoplasms (PV, ET, MF)• Leukemoid reaction• Acute leukemias📌 Diagnosis• FBC: ↑ WCC, left shift, basophilia• Blood film: spectrum of granulocytes• Bone marrow biopsy• Cytogenetics: Philadelphia chromosome (t(9;22))• Molecular: BCR-ABL via PCR/FISH💡 Tip: Blood film resembling marrow sample is a CML clue📌 Management• First-line: Tyrosine kinase inhibitors (TKIs), e.g. imatinib• Alternatives: dasatinib, nilotinib for resistance/intolerance• Monitor via:– Hematologic remission (blood counts)– Cytogenetic remission (Ph+ cells)– Molecular remission (BCR-ABL levels)• Stem cell transplant (allo-HSCT) for refractory cases💡 NICE: Imatinib usually first-line in chronic phasehttps://www.nice.org.uk/guidance/ta251📌 Complications• Blast crisis (progression to acute leukaemia)• Resistance to TKIs• Organ damage from hyperviscosity• Side effects from long-term therapy📌 Prognosis• Excellent with treatment:– 5-year survival >90%– 10-year survival ~84%– Many achieve deep molecular remission• Worse prognosis if blast phase or resistant mutations📎 More MSRA Resources for Chronic Myeloid Leukaemia (CML)📝 Revision Notes: https://www.passthemsra.com/topic/chronic-myeloid-leukaemia-cml-revision-notes/🧠 Flashcards: https://www.passthemsra.com/topic/chronic-myeloid-leukaemia-cml-flashcards/💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/chronic-myeloid-leukaemia-cml-accordion-qa-notes/🚀 Rapid Quiz: https://www.passthemsra.com/topic/chronic-myeloid-leukaemia-cml-rapid-quiz/🎓 Full Course: https://www.passthemsra.com/courses/paediatrics-for-the-msra/#MSRA #MSRARevision #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQ&ANotes #MSRAAccordions #MultiSpecialityRecruitmentAssessment #MSRAOnlineRevision #MSRARevisionWebsite #ChronicMyeloidLeukaemia #CML