The difference between chronic granulocytic leukemia and leukemia.

Written by Li Fang Fang
Hematology
Updated on October 30, 2024
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Chronic granulocytic leukemia is a type of leukemia. Leukemia can be divided into acute leukemia and chronic leukemia. Acute leukemia is further divided into acute myeloid leukemia and acute lymphoblastic leukemia. Among these, acute myeloid leukemia can be divided into eight subtypes from M0 to M7, and acute lymphoblastic leukemia can be divided into three subtypes from L0 to L3. Chronic leukemia is further divided into chronic granulocytic leukemia and chronic lymphocytic leukemia. Therefore, chronic granulocytic leukemia is a subtype of leukemia.

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How is leukemia treated?

Leukemia treatment currently mainly consists of three aspects: supportive care, chemotherapy, and transplantation. Supportive care refers to actively preventing and treating infections, as well as transfusing red blood cells and platelets in leukemia patients, who often suffer from repeated infections, anemia, and bleeding. Chemotherapy can be divided into oral chemotherapy and intravenous chemotherapy, depending on the specific type of leukemia. Transplantation can be divided into autologous hematopoietic stem cell transplantation and allogeneic hematopoietic stem cell transplantation. Autologous transplantation costs less and has fewer side effects but has a higher relapse rate. Allogeneic transplantation is more costly, has more severe side effects, but a lower relapse rate. Whether to undergo autologous or allogeneic hematopoietic stem cell transplantation depends on the specific type of disease and the patient's individual circumstances.

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chronic granulocytic leukemia course

The course of chronic granulocytic leukemia is relatively long, as it is a type of chronic leukemia. Its onset is gradual, and its natural course includes four stages: asymptomatic phase, chronic phase, accelerated phase, and blast crisis phase. Most patients seek medical attention and are diagnosed only after symptoms appear, with very few patients discovering blood abnormalities during physical examinations or blood tests conducted for other reasons. At this point, the spleen may already be mildly enlarged, or not enlarged at all. In the early stages of the disease, some patients may experience an absolute increase in basophilic granulocytes. When the white blood cell count is less than 20×10^9/L, there is a decrease in neutrophil alkaline phosphatase activity in peripheral blood, and this decreases further as the disease progresses. When the white blood cell count exceeds 40×10^9/L, the spleen can be felt below the ribs. Between 30 and 90×10^9/L, a range of related clinical symptoms may appear.

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Chronic granulocytic leukemia symptoms

The clinical symptoms of chronic myeloid leukemia can be divided into two phases: 1. During the chronic phase, the earliest subjective symptoms include fatigue, dizziness, and abdominal discomfort. Other symptoms may also appear such as general malaise, decreased endurance, and nausea. Some patients may exhibit signs of increased basal metabolism, such as sweating, weight loss, palpitations, and nervousness. As the disease progresses, patients may experience enlargement of the liver and spleen. An enlarged spleen can cause abdominal bloating, discomfort in the upper left abdomen, and a feeling of fullness after eating. In a few cases, bleeding may occur in the early stages. In female patients, excessive menstruation is common, and while bone pain and joint pain are less common at initial diagnosis, they can also occur. 2. During the accelerated phase, patients often exhibit unexplained low-grade fever, fatigue, lack of appetite, night sweats, and increased weight loss. These symptoms are accompanied by rapid enlargement of the spleen causing discomfort and fullness, sudden swelling of lymph nodes, clear sternal tenderness, and osteolytic changes in bones leading to bone pain. Anemia also progressively worsens. Once patients enter the blast crisis phase, they may show extramedullary infiltration symptoms such as skin nodules, testicular infiltration, abnormal penile erections, and the appearance of green tumors in the eye sockets, among other serious complications.

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Differentiation between Leukemoid Reaction and Leukemia

Leukemoid reactions and acute leukemia can both present with fever and elevated white blood cell counts, but there are clear differences between the two. Leukemoid reactions are often caused by severe bacterial or viral infections, with the main symptom being fever. Blood tests may show an increase in white blood cells, primarily neutrophils, and peripheral blood smear can reveal myelocytes and metamyelocytes. Leukemia can also involve an increase in white blood cells and fever when there is a concurrent infection, but blood tests will also show reductions in hemoglobin and platelets. Neutrophil alkaline phosphatase score is significantly elevated in patients with leukemoid reactions, while it is generally normal in patients with leukemia. A bone marrow examination can easily differentiate between leukemoid reactions and leukemia.

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Causes of Chronic Myeloid Leukemia

Chronic granulocytic leukemia, also known as chronic myeloid leukemia, is a myeloproliferative tumor originating from pluripotent stem cells. It is characterized by a specific chromosomal alteration, commonly referred to as the Philadelphia chromosome, which is formed by the translocation of chromosomes 9 and 22, resulting in the formation of the BCR-ABL fusion gene at the molecular level. Chronic granulocytic leukemia is a clonal disease originating from pluripotent stem cells. Due to a significant expansion of the progenitor cell pool, there is excessive proliferation of myeloid cells and increased granulocyte production. The slow clearance of granulocytes leads to the accumulation of granulocytes in the body, which is the main cause of the disease.