Criteria for accelerated and blast phases of CML
| CML, accelerated phase (AP) |
| Diagnose if one or more of the following is present: |
| Blasts 10% to 19% of peripheral blood white cells or bone marrow cells |
| Peripheral blood basophils at least 20% |
| Persistent thrombocytopenia (< 100 × 109/L) unrelated to therapy, or persistent thrombocytosis (> 1000 × 109/L) unresponsive to therapy |
| Increasing spleen size and increasing WBC count unresponsive to therapy |
| Cytogenetic evidence of clonal evolution (ie, the appearance of an additional genetic abnormality that was not present in the initial specimen at the time of diagnosis of chronic phase CML) |
| Megakaryocytic proliferation in sizable sheets and clusters, associated with marked reticulin or collagen fibrosis, and/or severe granulocytic dysplasia, should be considered as suggestive of CML-AP. These findings have not yet been analyzed in large clinical studies, however, so it is not clear if they are independent criteria for accelerated phase. They often occur simultaneously with one or more of the other features listed. |
| CML, blast phase (BP) |
| Diagnose if one or more of following is present: |
| Blasts 20% or more of peripheral blood white cells or bone marrow cells |
| Extramedullary blast proliferation |
| Large foci or clusters of blasts in bone marrow biopsy |
| CML, accelerated phase (AP) |
| Diagnose if one or more of the following is present: |
| Blasts 10% to 19% of peripheral blood white cells or bone marrow cells |
| Peripheral blood basophils at least 20% |
| Persistent thrombocytopenia (< 100 × 109/L) unrelated to therapy, or persistent thrombocytosis (> 1000 × 109/L) unresponsive to therapy |
| Increasing spleen size and increasing WBC count unresponsive to therapy |
| Cytogenetic evidence of clonal evolution (ie, the appearance of an additional genetic abnormality that was not present in the initial specimen at the time of diagnosis of chronic phase CML) |
| Megakaryocytic proliferation in sizable sheets and clusters, associated with marked reticulin or collagen fibrosis, and/or severe granulocytic dysplasia, should be considered as suggestive of CML-AP. These findings have not yet been analyzed in large clinical studies, however, so it is not clear if they are independent criteria for accelerated phase. They often occur simultaneously with one or more of the other features listed. |
| CML, blast phase (BP) |
| Diagnose if one or more of following is present: |
| Blasts 20% or more of peripheral blood white cells or bone marrow cells |
| Extramedullary blast proliferation |
| Large foci or clusters of blasts in bone marrow biopsy |