Abstract

Chronic myeloid leukemia (CML) represents a common condition in the spectrum of myeloproliferative disorders (MPD). It classically exhibits leukocytosis, but rarely presents with isolated thrombocytosis. This paper is designed to review the clinicopathologic features, treatment, and outcomes of patients with CML who present with isolated thrombocytosis.We searched PubMed, MEDLINE®, ScienceDirect, and Scopus for English-language articles about case series and case reports for the period 2000-2020 with the terms “chronic myeloid leukemia” and “thrombocytosis” and pooled them with a case from our institution. Cases were also incorporated from the reference list and screened for inclusion. A total of 20 cases were included in the final cohort. The male-to-female ratio was 1:1.86. The mean age of the patients at the time of initial diagnosis was 40.5 years (range: 9-77 years). Out of 17 cases with available data, seven (41%) were asymptomatic and found to have thrombocytosis incidentally upon routine blood work. Five cases (29.4%) either had a history of thrombotic events or presented with severe thrombotic complications, including ischemic cerebrovascular accidents (CVA), myocardial infarction (MI), pulmonary embolism (PE), and/or miscarriages. Four cases (23.5%) had more than one symptom at presentation, including headache, syncope, and bruising. The average platelet count was 1,923 × 109/L (range: 584-8,688 × 109/L), and one case (5%) had anemia. The bone marrow (BM) examination showed normal cellularity and normal myeloid to erythroid (M/E) ratio in seven (50%) and 11 (84.6%) out of the 14 and 13 cases with reported data, respectively. Moreover, megakaryocytes in the BM were small in 10 cases (71.4%), pleomorphic in three cases (21.4%), and dysplastic in one case (7.1%).Accurate differentiation among MPD subtypes and the exclusion of CML is critical in reaching a proper diagnosis to decide on proper therapy and eventually modify outcomes. Prompt evaluation for the precise diagnosis of patients presenting with isolated marked thrombocytosis will help expedite their diagnosis and initiation of a specific tyrosine kinase inhibitor (TKI) therapy, thereby promptly inducing remission, preventing thrombotic complications, and avoiding adverse drug events, which would eventually improve outcomes.

Highlights

  • BackgroundChronic myeloid leukemia (CML) belongs to the spectrum of myeloproliferative disorders (MPD), which are myeloid lineage clonal disorders that include essential thrombocythemia, polycythemia vera, and myelofibrosis [1]

  • This review aimed to investigate the available published data on the clinical characteristics, treatment, and prognosis of CML in patients presenting with isolated thrombocytosis

  • We performed a systematic review of the PubMed, MEDLINE®, ScienceDirect, and Scopus databases for the published literature in the English language during the period 2000-2020 that reported isolated thrombocytosis as an initial presentation in laboratory-confirmed CML patients

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Summary

Introduction

Chronic myeloid leukemia (CML) belongs to the spectrum of myeloproliferative disorders (MPD), which are myeloid lineage clonal disorders that include essential thrombocythemia, polycythemia vera, and myelofibrosis [1]. It accounts for 15-20% of all adult leukemia cases, with an estimated incidence of fewer than 5,000 new cases in the United States per year [2,3]. When patients present with isolated thrombocytosis, testing for the Philadelphia chromosome or BCR-ABL is essential to identify CML cases among them [4]. This study reviews the clinical characteristics, diagnosis, therapeutic modalities, and prognosis regarding patients with isolated thrombocytosis as an initial presentation of CML.

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