Classification systems used in chronic myeloid leukemia, including recent updated guideline recommendations
| . | European LeukemiaNet6,49 . | WHO 20165 . | ICC 20224 . | WHO 20223 . |
|---|---|---|---|---|
| Accelerated phase | PB or BM blasts 15%-29% | PB or BM blasts 10%-19% | BM or PB blasts 10%-19% | |
| PB blasts + promyelocytes ≥30% | ||||
| PB basophils ≥20% | PB basophils ≥20% | Peripheral blood basophils ≥20% | ||
| Platelets ≤100 × 109/L (unrelated to therapy) | Platelets ≤100 × 109/L (unrelated to therapy) or >1000 × 109/L (unresponsive to therapy) | |||
| Splenomegaly (unresponsive to therapy) | ||||
| Cytogenetic evolution on treatment | ACA in Ph+ cells at diagnosis, including major route, complex karyotype, or 3q26.2 abnormalities, at diagnosis Cytogenetic evolution on treatment | ACA in Ph+ cells | ||
| Consider: ACAs in Ph+ cells Resistance to 2 TKIs Detection of a BCR::ABL1 kinase domain mutation | Provisional: Failure to achieve CHR to first TKI Any indication of resistance to 2 sequential TKIs Occurrence of >2 mutations on BCR::ABL1 during TKI | |||
| Blast phase | PB or BM blasts ≥30% | PB or BM blasts ≥20% | BM or PB blasts ≥20% | BM or PB blasts ≥20% |
| Extramedullary blast proliferation | Extramedullary blast proliferation | Myeloid sarcoma | Myeloid sarcoma | |
| Presence of morphologically apparent lymphoblasts (>5%) warrants consideration of lymphoid BP-CML | Presence of increased lymphoblasts in PB or BM |
| . | European LeukemiaNet6,49 . | WHO 20165 . | ICC 20224 . | WHO 20223 . |
|---|---|---|---|---|
| Accelerated phase | PB or BM blasts 15%-29% | PB or BM blasts 10%-19% | BM or PB blasts 10%-19% | |
| PB blasts + promyelocytes ≥30% | ||||
| PB basophils ≥20% | PB basophils ≥20% | Peripheral blood basophils ≥20% | ||
| Platelets ≤100 × 109/L (unrelated to therapy) | Platelets ≤100 × 109/L (unrelated to therapy) or >1000 × 109/L (unresponsive to therapy) | |||
| Splenomegaly (unresponsive to therapy) | ||||
| Cytogenetic evolution on treatment | ACA in Ph+ cells at diagnosis, including major route, complex karyotype, or 3q26.2 abnormalities, at diagnosis Cytogenetic evolution on treatment | ACA in Ph+ cells | ||
| Consider: ACAs in Ph+ cells Resistance to 2 TKIs Detection of a BCR::ABL1 kinase domain mutation | Provisional: Failure to achieve CHR to first TKI Any indication of resistance to 2 sequential TKIs Occurrence of >2 mutations on BCR::ABL1 during TKI | |||
| Blast phase | PB or BM blasts ≥30% | PB or BM blasts ≥20% | BM or PB blasts ≥20% | BM or PB blasts ≥20% |
| Extramedullary blast proliferation | Extramedullary blast proliferation | Myeloid sarcoma | Myeloid sarcoma | |
| Presence of morphologically apparent lymphoblasts (>5%) warrants consideration of lymphoid BP-CML | Presence of increased lymphoblasts in PB or BM |
ACA, additional clonal cytogenetic abnormalities; BM, bone marrow; CHR, complete hematologic remission; PB, peripheral blood.