Table 17.2 Diagnostic criteria for accelerated phase

Blasts 15-29%a

Blasts plus promyelocytes >30% (with blasts alone <30%)a

Basophils >20%a

Platelets <100 X 109/L, unrelated to therapy aRefers to peripheral blood or bone marrow.

completely. The most widely accepted criteria are given in Table 17.2.10 Percentages of blasts, promyelocytes, and basophils, as well as thrombocytopenia that is not related to therapy, were all demonstrated to be independent adverse prognostic indicators in multivariate analysis, and these parameters were used to define accelerated phase in the recent large trials of imatinib in advanced CML.11 It is controversial whether clonal evolution (CE), i.e., the presence of cytogenetic abnormalities in addition to the Ph chromosome, is indicative of accelerated phase at diagnosis in the absence of any of the other criteria. However, there is consensus that CE in a patient undergoing therapy indicates disease progression. In addition to the criteria in Table 17.2, a number of "soft" parameters are used clinically, such as decreased responsiveness to drug therapy, increasing splenomegaly, or pronounced B symptoms. Although features like this are clearly suggestive of disease progression, they are difficult to cast into an unambiguous definition and therefore should not be used in isolation to establish a diagnosis of accelerated phase.

0 0

Post a comment