Chronic myelogenous leukemia staging
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]
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 a aggressive phase that becomes life-threatening. Relapsed CML means that the number of blast cells in the blood and bone marrow increase after remission and finally, refractory disease means the leukemia did not respond to treatment.
PMID:20221270/PMID:24729196
CML is usually diagnosed in the initial, chronic phase (CP), which if left untreated advances to an accelerated phase (AP) after three to five years, and finally a blast crisis (BC). Leukocytosis of more than 100 000/µL with continuous left shift leading to myeloblasts or promyelocytes and splenomegaly are characteristic of the chronic phase. The features of the accelerated phase are as follows:
- Increased numbers of blast cells in the blood or bone marrow
- Increased or decreased platelet count
- Increased numbers of basophils in the peripheral blood or
- Other chromosome anomalies (e8).
The blast crisis, with increased blast cell numbers (=20%) in the blood or bone marrow, matches the clinical picture of acute leukemia. Monitoring of CML during therapy includes measuring bcr-abl levels in the blood and bone marrow, as well as blood counts. This is why three separate levels of response are distinguished.PMID:20221270
Classification
Chronic myelogenous leukemia is often divided into five phases based on clinical characteristics and laboratory findings.[1]
- Chronic. The chronic phase is the earliest phase and generally has the best response to treatment.
- 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.
References
- ↑ Canadian Cancer Society.2015.http://www.cancer.ca/en/cancer-information/cancer-type/leukemia-chronic-myelogenous-cml/staging/?region=ab