History and exam

Key diagnostic factors

common

splenomegaly

Occurs in 20% to 40% of patients.[30][31]

uncommon

shortness of breath

May occur on exertion.

left upper quadrant discomfort or fullness

Sensation of a mass in the left upper quadrant.[11][31]

Due to splenomegaly or splenic infarct.

epistaxis

Due to thrombocytopenia or abnormal platelet function.

arthralgia

Can occur due to increased uric acid production from extensive cell turnover.

sternal tenderness

Due to bone marrow expansion of the sternum.

Other diagnostic factors

common

weight loss

More likely to occur in accelerated and blast phases.

excessive sweating

More likely to occur in accelerated and blast phases.

uncommon

fever

Rare at presentation.[11]

More likely to occur in accelerated and blast phases.

pallor

Due to anemia caused by bone marrow infiltration of leukemic cells.

bruising

Spontaneous or excessive bruising may occur.

retinal hemorrhages

May rarely be present.[30]

Risk factors

strong

age 65 to 74 years

In the US, incidence peaks between the ages of 65 and 74 years.[12]

Median age at diagnosis in the US is 66 years.[12]

In Southeast Asia, median age at diagnosis is considerably lower.[23][24][25][26] Environmental and demographic factors may contribute to this discrepancy.

weak

ionizing radiation exposure

Case series and literature reviews report secondary CML following radiation therapy.[15][27][28]

A positive association exists between cumulative dose of ionizing radiation and death caused by CML among nuclear industry workers.[17][29]

An increased incidence of CML has been reported in Japanese atomic bomb survivors; risk appears to be greater with exposure to higher radiation doses.[16]

male sex

CML is more common in males (age-adjusted rate of new cases per 100,000 people [all races] 2.5 males:1.5 females).[12]

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