List of the criteria that have been proposed by the WHO23 and of the criteria that have been used in most recent studies and in this review, for defining AP
WHO criteria23 . | Other criteria, including this report15 -22 . |
|---|---|
| Blast cells in blood or bone marrow 10%-19% | Blast cells in blood or bone marrow 15%-29%; blast cells plus promyelocytes in blood or bone marrow more than 30%, with blast cells less than 30% |
| Basophils in blood 20% or more | Basophils in blood 20% or more |
| Persistent thrombocytopenia (platelet count less than 100 × 109/L) unrelated to therapy | Persistent thrombocytopenia (platelet count less than 100 × 109/L) unrelated to therapy |
| Thrombocytosis (platelet count greater than 1000 × 109/L) unresponsive to therapy | Not included |
| Increasing spleen size and increasing WBC count unresponsive to therapy | Not included |
| Cytogenetic evidence of clonal evolution (the appearance of additional genetic abnormalities that were not present at the time of diagnosis) | Not included |
WHO criteria23 . | Other criteria, including this report15 -22 . |
|---|---|
| Blast cells in blood or bone marrow 10%-19% | Blast cells in blood or bone marrow 15%-29%; blast cells plus promyelocytes in blood or bone marrow more than 30%, with blast cells less than 30% |
| Basophils in blood 20% or more | Basophils in blood 20% or more |
| Persistent thrombocytopenia (platelet count less than 100 × 109/L) unrelated to therapy | Persistent thrombocytopenia (platelet count less than 100 × 109/L) unrelated to therapy |
| Thrombocytosis (platelet count greater than 1000 × 109/L) unresponsive to therapy | Not included |
| Increasing spleen size and increasing WBC count unresponsive to therapy | Not included |
| Cytogenetic evidence of clonal evolution (the appearance of additional genetic abnormalities that were not present at the time of diagnosis) | Not included |
The definition of CP implies that none of these criteria are met. For the definition of blast crisis (BC), the WHO-recommended criteria are the percentage of blast cells in blood or bone marrow (≥ 20%), extramedullary blast proliferation, or large foci or clusters of blasts in the bone marrow biopsy.23 In recent treatment reports15-22 and in this review, the criteria for BC were limited to the percent of blast cells in peripheral blood or bone marrow (≥ 30%, rather than ≥ 20% as for WHO), or extramedullary blast involvement. It should be noticed that the introduction of new treatments could change the boundaries between CP, AP, and BC, and modify to some extent the classic subdivision of CML into 3 phases.