GHleukemia occurs at all ages ALTHOUGH leukemia occurs at all ages of life, chronic granulocytic leukemia (CGL) is predominantly a disease of young adult life and early middle age1-3 (Fig 1). The usual case of CGL is that of a 20- to 50-year-old patient who complains of fatigue, a mass in the left subcostal region, or a sensation of fullness after eating. The spleen and liver are large and may half-fill the abdominal cavity. Laboratory studies usually reveal a leukocyte count that is greater than 100,000 cells/cu mm, with a predominance of granulocytes, including immature forms, and increased numbers of basophils. The cytoplasm of mature granulocytes contains a low concentration of alkaline phosphatase.4,5 Serum vitamin B12 levels are increased,6 and recently a chromosomal abnormality was described which may precede the clinical onset of leukemia.7-9 Treatment with radiation or chemotherapy usually produces improvement which lasts for months or years.10 Then the
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