Chronic Myeloid Leukemia Diagnosis

Successful leukemia treatment begins with an accurate and precise diagnosis. Many MD Anderson leukemia patients have been misdiagnosed before they come here for care. 

At MD Anderson, suspected leukemia cells are examined by pathologists who focus exclusively on diagnosing leukemia and its many subtypes. This allows MD Anderson to offer patients the most effective treatment for their specific disease. 

Diagnosing leukemia 

A leukemia diagnosis usually starts with a simple blood test, called a complete blood count. A doctor may order this blood test after evaluating the patient’s symptoms. Other times, the test is part of a routine check-up. 

If the test shows the presence of leukemia cells or abnormal levels of red blood cells, white blood cells or platelets, doctors may order the following tests. These tests can offer a definitive leukemia diagnosis and determine the extent of the disease. Tests are also used to monitor the disease’s progress and track how it responds to treatment. 

Biopsy: In a biopsy, suspected cancer cells are retrieved by the care team and studied under a microscope. For leukemia, patients undergo a bone marrow biopsy. This requires taking a sample of bone marrow from the hip with a needle to determine if cancerous cells are present. 

Genetic and molecular testing: If a patient is diagnosed with leukemia, additional tests can determine whether certain chromosomes or gene mutations are present in the diseased cells, or if they have specific proteins or molecules on their surface. This process, sometimes referred to as molecular profiling, can help doctors determine the patient's exact type of leukemia and his or her prognosis. Cancers with different genetic and molecular features can respond differently to treatments, so these tests can also help doctors create a treatment plan with the best chance of success. 

Lumbar puncture: While leukemia starts in the bone marrow, it may spread to the central nervous system (the brain and spinal cord). This is most common in acute lymphocytic leukemia but can occur in any type of leukemia. A lumbar puncture, also known as a spinal tap, can look for this spread by examining the patient’s spinal fluid. During this procedure, health care professionals use a needle to remove cerebrospinal fluid from the spine. The care provider may also administer a small dose of chemotherapy into the spinal fluid to kill leukemia cells that may be present. 

Imaging exams: Doctors may order imaging exams to look for the presence of cancer in different parts of the body. Learn more about imaging exams. 

CML phases

The extent or spread of cancer is usually described as stages, which describe how much and where cancer has spread in the body.

There are no stages for CML. Instead, the disease is described by phases. These are defined by how much of the blood and bone marrow is made up of immature blood cells, known as blasts.

The three phases are:
(Source: National Cancer Institute)

Chronic phase: In chronic phase CML, fewer than 10% of the cells in the blood and bone marrow are blast cells.

Accelerated phase: In accelerated phase CML, 10% to 19% of the cells in the blood and bone marrow are blast cells.

Blastic phase: In blastic phase CML, 20% or more of the cells in the blood or bone marrow are blast cells. When tiredness, fever, and an enlarged spleen occur during the blastic phase, it is called blast crisis.