About half of patients with CML are asymptomatic. CML is frequently diagnosed after blood tests are taken for unrelated reasons. Typical symptoms include fatigue, malaise, weight loss, sweats and symptoms related to an enlarged spleen.

Initial investigations by the GP include the following:

• a thorough patient history and examination, specifically looking for evidence of splenomegaly
• a full blood count will usually indicate the strong possibility of CML based on the numbers of WBC, platelets and the WBC differential. A pathologist report on the blood test will usually raise the possibility of CML based on the blood count and blood film, but this may not always be the case
• a PCR test on the peripheral blood to detect the BCR-ABL1 transcript in patients with a blood picture consistent with CML. This may be a quantitative or qualitative test.

Referral options

At the referral stage, the patient’s GP or other referring doctor should advise the patient about their options for referral, waiting periods, expertise, potential out- of-pocket costs and the range of services available. This will enable patients to make an informed choice of specialist and health service.

Communication

The GP’s responsibilities include:

• explaining to the patient and/or carer who they are being referred to and why
• supporting the patient and/or carer while waiting for specialist appointments
• informing the patient and/or carer that they can contact Cancer Council on 13 11 20 and the Leukaemia Foundation on 1800 620 420.

Checklist

• Signs and symptoms recorded
• Investigations completed
• Supportive care needs assessed and referrals to allied health services actioned as required
• Patient notified of support services such as Cancer Council 13 11 20 and the Leukaemia Foundation 1800 620 420
• Referral options discussed with the patient and/or carer including cost implications

Timeframe

Blood count results should be provided within 3 days of testing, or sooner if the patient is unwell.

The PCR test result may take days, or sometimes weeks, but the patient can be referred to a haematologist for further investigation in the interim.

If CML is suspected, non-urgent patients should ideally be seen by a specialist haematologist within 2 weeks. However, some cases may require immediate hospital admission or urgent assessment by a haematologist (e.g. WBC > 100, platelet count < 50 or > 800, priapism, symptoms of leukostasis, unexpected organ dysfunction or uncontrolled pain).