chronic myelocytic leukemia (CML), a malignant neoplasm of blood-forming tissues, characterized by a proliferation of granular leukocytes and, often, of megakaryocytes. The disease occurs most frequently in adults older than 50 years of age and begins insidiously. Also called chronic myelogenous leukemia. See also acute myeloid leukemia. ▪ OBSERVATIONS: Progress is marked by malaise, fatigue, heat intolerance, bleeding gums, purpura, skin lesions, weight loss, hyperuricemia, abdominal discomfort, and massive splenomegaly. Differential blood count and bone-marrow biopsies are performed to aid in the diagnosis. The alkaline phosphatase activity of the leukocytes is low, and the Philadelphia chromosome is present in myeloblasts in most patients with CML. ▪ INTERVENTIONS: Therapy with an oral alkylating agent is usual, but advanced CML is refractory to chemotherapy. Appropriate support and educational programs that address the physical and emotional effects of CML are an important component of management. ▪ PATIENT CARE CONSIDERATIONS: A highly collaborative environment, involving patients and their families, is important in the management of CML.
