Leukemia--Chronic Myeloid (Myelogenous)

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Early Detection, Diagnosis, and Staging TOPICS

How is chronic myeloid leukemia diagnosed?



Bone marrow aspiration and biopsy

These 2 tests are usually done at the same time. The samples are taken from the back of the pelvic (hip) bone, although in some cases the aspiration may be taken from the breastbone (sternum).



These samples are sent to a lab, and they are looked at under a microscope for leukemia cells. These tests may also be done after treatment to see if the leukemia is responding to treatment.

Lab tests


Blood cell counts and blood cell exam


Blood chemistry tests


Routine exam under a microscope

The samples of blood and bone marrow are looked at under a microscope by a pathologist (a doctor who specializes in diagnosing diseases with lab tests) and may be looked at by a hematologist/oncologist (a doctor specializing in treating blood diseases and cancer) as well.



An important feature of a bone marrow sample is how much of it is blood-forming cells. This is known as cellularity. Normal bone marrow contains both blood-forming cells and fat cells. When the bone marrow has more blood-forming cells than expected, it is said to be hypercellular. If too few of these cells are found, the marrow is called hypocellular. In people with CML, the bone marrow is often hypercellular because it is full of leukemia cells.

Genetic tests


Conventional cytogenetics: This test looks at chromosomes (pieces of DNA) under a microscope to find any changes. It is also called a karyotype. Because chromosomes can best be seen when the cell is dividing, a sample of blood or bone marrow has to be grown (in the lab) so that the cells start to divide. This takes time, and is not always successful. Normal human cells have 23 pairs of chromosomes, each of which is a certain size. The leukemia cells in many CML patients contain an abnormal chromosome known as the Philadelphia chromosome, which looks like a shortened version of chromosome 22. It is caused by swapping pieces (translocation) between chromosomes 9 and 22 (see "Do we know what causes chronic myeloid leukemia?"). Finding a Philadelphia chromosome is helpful in diagnosing CML. Even when the Philadelphia chromosome can't be seen, other tests can often find the BCR-ABL gene.



Imaging tests


Computed tomography scan



Instead of taking one picture like a regular x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into detailed images of the part of your body that is being studied.

Often before the test, you may be asked to drink a contrast solution that helps better outline abnormal areas in the body. This helps outline abnormal areas more clearly. You may also receive an IV (intravenous) line through which a different contrast dye (IV contrast) is injected. This also helps outline abnormal areas.

The IV injection of contrast dye can cause some flushing (redness and a feeling of warmth in the face or elsewhere). Some people are allergic to the dye and get hives. Rarely, more serious reactions like trouble breathing and low blood pressure can occur. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays.


Magnetic resonance imaging scan

Magnetic resonance imaging (MRI) scans are very helpful in looking at the brain and spinal cord. These scans can also be used to look at other areas of the body. MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed by the body and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into a very detailed image of parts of the body. Not only does this create images of cross-sectional slices of the body like a CT scanner, it can also produce images of slices that are parallel with the length of your body.

A contrast material might be injected, just as with CT scans, but this is done less often. This will be a different contrast from that used for CT scans, so being allergic to one doesn’t mean you are allergic to the other.

MRI scans take longer than CT scans, often up to an hour. You might have to lie inside a narrow tube, which is confining and can upset people with a fear of enclosed spaces. Special, "open" MRI machines may help with this problem. The MRI machine makes loud buzzing noises that you may find disturbing. Some places give you headphones or earplugs to help block this noise out.


Ultrasound uses sound waves and their echoes to make a picture of internal organs or masses. Most often for this test a small, microphone-like instrument called a transducer is placed on the skin (which is first lubricated with a gel). It gives off sound waves and picks up the echoes as they bounce off the organs. The echoes are converted by a computer into an image that is shown on a computer screen.



Last Medical Review: 02/24/2015
Last Revised: 02/24/2015