Clinical Presentation of Chronic Myeloid Leukaemia and Its Correlation with Haematological Parameters in Kenya

Background: Chronic myeloid leukaemia (CML) is commonly asymptomatic and is discovered incidentally in up to about 50% of patients in chronic phase, due to abnormally high white blood cell (WBC) counts. Commonest symptoms include fatigue and abdominal pain/discomfort, while some patients present with bleeding tendencies. Unusual manifestations include hearing and visual loss. Methods: This was a retrospective analysis of data from patients attending the Glivec International Patient Assistance Clinic at the Nairobi Hospital between January 2006 and December 2018. In-formation sourced included demographic profiles, findings on physical examination, and laboratory values. Absolute, range, median and mean counts for white blood cells (WBC ×109/l), ab-solute neutrophil count (ANC×109/l), platelets (PLT ×109/l), haemoglobin (hgb, g/dl), BCR:ABL1 baseline levels, and bone marrow blast percentage at diagnosis. All parameters were tested against each of the clinical presentations. Results: We enrolled 583 patients; the mean age was 39.8 years. The commonest symptom was abdominal swelling in 235 cases (40.3%); 70 (12%) experienced abdominal pain. Priapism occurred in 4 males (0.69%), blindness and deafness in 8 patients (1.37%). Splenomegaly was significantly more common among males than females (P = 0.015). Patients aged ≤ 20 years were more likely to be in heart failure (P = 0.032); leg swelling was more in those with high platelet counts (p=0.023). Unclear presentations were more common in those with high WBC counts (p=0.015). Total WBC counts and BCR:ABL1 levels were higher among younger patients (p=0.036, and 0.025, respectively). Patients with leg swelling had lower BCR:ABL1 levels (p=0.005), those in heart failure had significantly higher BCR:ABL1 levels at baseline compared with the rest (p=0.037). Patients with lymphadenopathy were more likely to have lower ANCs (p=0.035). Patients who had pallor had a significantly lower BCR:ABL1 values compared with those without (P = 0.025). Similarly, patients who had leg swelling had a significantly lower mean BCR:ABL1 percentage compared with those without (P = 0.005). In contrast, those in heart failure had significantly higher mean BCR:ABL1 values (P = 0.037). Those with lymphadenopathy had significantly lower absolute neutrophil counts compared with those without (P =0.035). Conclusions: Clinical manifestations of CML cannot be explained merely by haematologic values. Complex biologic and physico-chemical factors should be further interrogated.