International Journal of Hematology

, Volume 108, Issue 5, pp 465–484 | Cite as

Systematic review of pre-clinical chronic myeloid leukaemia

  • Jew Win KuanEmail author
  • Anselm Ting Su
  • Chooi Fun Leong
  • Motomi Osato
  • Goro Sashida
Review Article



Studies of a provisional entity pre-clinical chronic myeloid leukaemia (CML), which precedes chronic phase (CP) without leucocytosis or blood/marrow feature of CML CP, has been increasing.


To perform a systematic review of pre-clinical CML and analysis the data relevant to disease progression to CML CP.


We performed a literature search on 16 July 2017 using EBSCOhost Research Databases interface and Western Pacific Region Index Medicus. Two authors selected the studies, extracted the data and evaluated the quality of studies using an 8-item tool, independently. The outcomes were percentage of Philadelphia chromosome in the number of metaphases examined (Ph%), correlation between Ph% and blood count and time progress to CML.


Our initial search returned 4770 studies. A total of 10 studies with a total 17 subjects were included. The lowest Ph%, which eventually progresses to CML, was 10%. Absolute basophil count seemed to correlate better with Ph% compared to total white cell and absolute eosinophil count. The time from the first documented pre-clinical CML to CML ranged from 12 to 48 months. The overall quality of the included studies was average.


This is the first systematic review on pre-clinical CML. This entity requires additional large-scale studies.


Chronic myeloid leukaemia Pre-clinical Asymptomatic Smoldering 



We would like to thank Mr Sho Kubota for translating articles [1] in Japanese and Centre For Academic Information Services, Universiti Malaysia Sarawak for retrieving full text of the articles.

Authors contribution

KJW initiated and planned the review, designed search term, screened title/abstract/article, searched full texts, performed data extraction and quality assessment, performed data analysis and interpretation, wrote the review. AST searched electronic databases, designed method of quality assessment, provided statistical consultation, wrote (main author) the sections involving quality assessment, reviewed manuscript. LCF screened title/abstract/article, performed data extraction and quality assessment, reviewed manuscript. MO supervised the work, reviewed manuscript. GS supervised the work, confirming data of article in Japanese [2], reviewed manuscript.


This study was funded by JSPS RONPAKU (Dissertation PhD) Program FY2017, UNIMAS Special Grant Scheme No: F05/SpGS/1401/16/2 & Fundamental Research Grant Scheme No: FRGS/SKK01(01)/1290/2015(7).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© The Japanese Society of Hematology 2018

Authors and Affiliations

  1. 1.Department of Medicine, Faculty of Medicine and Health SciencesUniversiti Malaysia SarawakKota SamarahanMalaysia
  2. 2.Department of Community Medicine and Public Health, Faculty of Medicine and Health SciencesUniversiti Malaysia SarawakKota SamarahanMalaysia
  3. 3.Department of PathologyUniversiti Kebangsaan Malaysia Medical CenterKuala LumpurMalaysia
  4. 4.International Research Center for Medical SciencesKumamoto UniversityKumamotoJapan

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