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Diagnosis and tests

Symptoms of CML

The related article (“CML: symptoms, phases and diagnosis”) explains bone marrow aspiration. This topic looks closely at the symptoms of chronic myeloid leukaemia (CML): why it is often hidden and how it changes by phase.

Last updated: ~1 min read
A chance finding on a routine test
Figure 1.A chance finding on a routine test.

01Short answer

CML develops slowly, and many people (around half) have no symptoms; it is found because of a high white count on a routine blood test. When there are symptoms, they usually come on gradually: tiredness, night sweats, weight loss, poor appetite, and heaviness under the left ribs or feeling full quickly because of an enlarged spleen. Sometimes platelets are very high. CML has three phases: the chronic phase (most people are diagnosed in this phase), the accelerated phase and the blast phase. In the later phases, symptoms resemble acute leukaemia: anaemia, bleeding, infections, fever and bone pain. With modern treatment, most people stay in the chronic phase.

02Simple explanation

Often no symptoms: found by chance.

The spleen: heaviness on the left.

Phases: chronic, accelerated, blast.

03Scientific explanation

Splenomegaly: the spleen is often enlarged at diagnosis and shrinks with treatment; a large spleen can cause sudden pain.

Phase change: the blast percentage, basophils and new chromosome changes are used to define the phase.

04What happens in the body?

A chance finding

CML is often found on an ordinary blood test.

An enlarged spleen

Heaviness under the left ribs and feeling full quickly.

A body with a highlighted spleen.
Figure 2.An enlarged spleen on the left.

Three phases

Treatment usually prevents moving from the chronic to the blast phase.

A three-coloured path.
Figure 3.The three phases of CML.

05How CML shows up

Four steps.

No symptoms — A routine check.1No symptomsA routine check.
Spleen — Heaviness on the left.2SpleenHeaviness on the left.
General — Tiredness, sweats.3GeneralTiredness, sweats.
Blood — A high white count.4BloodA high white count.

06Phases of CML

PhaseSymptoms
ChronicOften none or mild
AcceleratedGrowing tiredness, spleen, anaemia
BlastLike acute leukaemia: bleeding, infection, fever

07Key terms

CML
Chronic myeloid leukaemia.
Splenomegaly
An enlarged spleen.
Chronic phase
The early, stable stage of CML.
Blast phase
A stage that resembles acute leukaemia.
Basophil
A type of white cell that can rise in CML.

08Key points

  • CML often causes no symptoms.
  • It may be found by chance.
  • The spleen can enlarge.
  • Tiredness and sweats may occur.
  • There are three phases.
  • With treatment it usually stays chronic.

09Frequently asked questions

I have no symptoms; why do I need treatment?

Treatment prevents the disease moving into later phases.

When is spleen pain dangerous?

With sudden severe pain, seek help at once.

Does CML occur in children?

Rarely, but it does.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. I have no symptoms; why do I need treatment?

  2. When is spleen pain dangerous?

  3. Does CML occur in children?

My questions

12Sources

  1. National Cancer Institute (NCI). CML treatment (PDQ), patient version
  2. National Cancer Institute (NCI). Definition: Philadelphia chromosome
  3. MedlinePlus (U.S. National Library of Medicine). White Blood Count (WBC)
  4. National Comprehensive Cancer Network (NCCN). NCCN Guidelines for Patients: Acute Myeloid Leukemia
  5. NHS. Acute myeloid leukaemia — Tests and next steps
  6. Cancer Research UK. Tests for acute myeloid leukaemia (AML)
  7. Annals of Oncology (ESMO), 2020. Acute myeloid leukaemia in adult patients: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
  8. American Cancer Society. Tests for Childhood Leukemia
  9. Blood Cancer United (formerly The Leukemia & Lymphoma Society). Acute lymphoblastic leukemia (ALL) diagnosis
  10. National Comprehensive Cancer Network (NCCN). NCCN Guidelines for Patients: Acute Lymphoblastic Leukemia
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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