Chronic myelogenous leukemia staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Badria Munir M.B.B.S.[2] Mohamad Alkateb, MBBCh [3] Sima NoorAli, M.D.

Overview

Chronic myelogenous leukemia may be classified according to the clinical characteristics and laboratory findings into five phases: chronic phase, accelerated phase, blast crisis, relapsed or recurrent CML and refractory disease. The earliest phase is the chronic phase and generally has the best response to treatment. The accelerated phase is a transitional phase and blastic phase is an aggressive phase that becomes life-threatening. Relapsed CML means that the number of blast cells in the blood and bone marrow increase after remission. Finally, primary refractory disease means the leukemia did not respond to initial treatment.

Classification

Chronic myelogenous leukemia is often divided into five phases based on clinical characteristics and laboratory findings.[1][2][3]

  • Chronic. The chronic phase is the earliest phase and generally has the best response to treatment.
    • Chronic phase (CP), if left untreated advances to an accelerated phase (AP) after three to five years.
    • Leukocytosis of more than 100 000/µL with continuous left shift leading to myeloblasts or promyelocytes is a characteristic of the chronic phase.
    • Splenomegaly is a characteristic of the chronic phase.
  • Accelerated. The accelerated phase is a transitional phase when the disease becomes more aggressive.
  • Blastic. Blastic phase is a severe, aggressive phase that becomes life-threatening.
  • Relapsed CML. Relapsed, or recurrent CML means that the number of blast cells in the blood and bone marrow increase after treatment.
  • Refractory disease. It means the leukemia did not respond to treatment.

Name of Diagnostic Criteria:

* Modified MD Anderson Criteria Different Phases of Chronic Myeloid Leukemia[4][5]
CML chronic phase CML accelerated phase CML blast phase
  • Granulocytosis in the presence of Ph chromosome and/or BCR-ABL translocation
  • Increasing spleen size and WBC count unresponsive to therapy
  • Blasts ≥ 30% in perpheral blood and bone marrow
  • No sign of CML accelerated phase
  • Peripheral blood myeloblasts 15–29% in peripheral blood and/or bone marrow, or
  • Peripheral blood myelocytes plus promyelocytes combined 30% or greater, or
  • Peripheral blood basophils ≥ 20%
  • Extramedullary blast proliferation
  • Persistent thrombocytopenia (< 100 x 10^9/L) unrelated to therapy or
  • Persistent thrombocytosis (> 1000 x 10^9/L) unresponsive to therapy
  • Large foci or clusters of blasts in the bone marrow biopsy

References

  1. Canadian Cancer Society.2015.http://www.cancer.ca/en/cancer-information/cancer-type/leukemia-chronic-myelogenous-cml/staging/?region=ab
  2. von Bubnoff N, Duyster J (February 2010). "Chronic myelogenous leukemia: treatment and monitoring". Dtsch Arztebl Int. 107 (7): 114–21. doi:10.3238/arztebl.2010.0114. PMC 2835925. PMID 20221270.
  3. Jabbour E, Kantarjian H (May 2014). "Chronic myeloid leukemia: 2014 update on diagnosis, monitoring, and management". Am. J. Hematol. 89 (5): 547–56. doi:10.1002/ajh.23691. PMID 24729196.
  4. Empty citation (help)
  5. Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, Bloomfield CD, Cazzola M, Vardiman JW (May 2016). "The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia". Blood. 127 (20): 2391–405. doi:10.1182/blood-2016-03-643544. PMID 27069254.

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