Chronic Myelogenous Leukemia Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage Information for Chronic Myelogenous Leukemia (CML)
Studies have suggested that certain presenting features have prognostic significance. The following are predictive of a shorter chronic phase:
- Increased splenomegaly.
- Older age.
- Male gender.
- Elevated serum lactate dehydrogenase.
- Cytogenetic abnormalities in addition to the Ph1.
- A higher proportion of marrow or peripheral blood blasts.
Predictive models using multivariate analysis have been derived.[2,3,5,6,7,8]
Chronic-phase CML is characterized by bone marrow and cytogenetic findings as described above with less than 10% blasts and promyelocytes in the peripheral blood and bone marrow.
Accelerated-phase CML is characterized by 10% to 19% blasts in either the peripheral blood or bone marrow.
Blastic-phase CML is characterized by 20% or more blasts in the peripheral blood or bone marrow.
When 20% or more blasts are present in the face of fever, malaise, and progressive splenomegaly, the patient has entered blast crisis.
Relapsed CML is characterized by any evidence of progression of disease from a stable remission. This may include the following:
- Increasing myeloid or blast cells in the peripheral blood or bone marrow.
- Cytogenetic positivity when previously cytogenetic-negative.
- FISH positivity for BCR/ABL (breakpoint cluster region/Abelson) translocation when previously FISH-negative.
Detection of the BCR/ABL translocation by RT-PCR during prolonged remissions does not constitute relapse on its own. However, exponential drops in quantitative RT-PCR measurements for 3 to 12 months correlates with the degree of cytogenetic response, just as exponential rises may be associated with quantitative RT-PCR measurements that are closely connected with clinical relapse.
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