Table 1.
Definitions of accelerated and blast phase of chronic myeloid leukemia.
| Criteria | IBMTR | MDACC | ELN | WHO |
|---|---|---|---|---|
| ACCELERATED PHASE | ||||
| Blasts (PB or BM) | 10–29% | 15–29% | 15–29% | 10–19% |
| Blasts plus promyelocytes (PB or BM) | >20% | ≥30% with blasts <30% | ≥30% with blasts <30% | – |
| Basophils (PB) | ≥20% | ≥20% | ≥20% | ≥20% |
| WBC | >100 × 109/L | >100 × 109/L | – | unresponsive to tx |
| Thrombocytopenia | <100 × 109/L unrelated to therapy |
<100 × 109/L unrelated to therapy |
<100 × 109/L unrelated to therapy |
<100 × 109/L unrelated to therapy |
| Thrombocytosis | >1,000 × 109/L unresponsive to tx |
– | – | >1,000 × 109/L unresponsive to tx |
| Anemia | Hb <8 g/dL, unresponsive to tx |
– | – | – |
| Splenomegaly | Unresponsive to tx | Unresponsive to tx | – | Unresponsive to tx |
| Cytogenetics | CE, on treatment | CE, on treatment | ACA/Ph+ major route, on treatment | ACA/Ph+ major route, complex karyotype, or 3q26.2 abnormalities, at diagnosis; any new ACA/Ph+, on treatment |
| Response to TKI (provisional criteria) | – | – | – | Failure to achieve CHR to the first TKI, or Any hematological, cytogenetic, or molecular indication of resistance to 2 sequential TKIs, or Occurrence of ≥2 mutations in BCR-ABL1 during TKI therapy |
| BLAST PHASE | ||||
| Blasts (PB or BM) | ≥30% | ≥30% | ≥30% | ≥20% |
| Other | Extramedullary blast proliferation (apart from spleen) | Extramedullary blast proliferation (apart from spleen) | Extramedullary blast proliferation (apart from spleen) | Extramedullary blast proliferation, or large foci or clusters of blasts in the BM biopsy |
IBMTR, International Blood and Marrow Transplant Registry; MDACC, M.D. Anderson Cancer Center; ELN, European LeukemiaNet; WHO, World Health Organization; PB, peripheral blood; BM, bone marrow; CE, clonal evolution; ACA/Ph+, additional chromosome abnormalities in Philadelphia-positive cells; CHR, complete hematologic response.