De novo accelerated phase of chronic myeloid leukemia should be recognized even in the era of tyrosine kinase inhibitors
| Authors | |
|---|---|
| Year of publication | 2024 |
| Type | Article in Periodical |
| Magazine / Source | American Journal of Hematology |
| MU Faculty or unit | |
| Citation | |
| Web | https://onlinelibrary.wiley.com/doi/10.1002/ajh.27229 |
| Doi | http://dx.doi.org/10.1002/ajh.27229 |
| Keywords | chronic myeloid leukemia; tyrosine kinase inhibitors |
| Description | Chronic myeloid leukemia (CML) has been described as a triphasic disease for several decades. Before the introduction of tyrosine kinase inhibitors (TKIs), the course of the disease ran from the chronic phase to the accelerated phase (AP), noticeable by changes in the complete blood count, with left shift, additional cytogenetic changes, etc. The original definition of AP was proposed by the MD Anderson group. Disease then progressed to blast crisis (BC), with a portion of blast cells in the blood or bone marrow comparable to acute leukemias. Most patients with CML experienced all three phases, with those progressing to AP and BC having a poor prognosis. This has been recognized in the most renowned CML classifications and guidelines, including the WHO and ICC classifications, and the ELN and NCCN guidelines. The criteria for AP and BC were defined, although some differences existed among the classifications (e.g., blast percentage thresholds and certain cytogenetic abnormalities). After the TKI revolution in CML treatment, the situation completely changed. Patients receiving TKIs rarely progress to advanced phases; in some cases, the progression to blast crisis seems to be rapid, often without signs of AP. In light of this fact, the latest WHO 2022 classification deemed AP less relevant and suggested its omission. This step has sparked numerous discussions. Notably, there are two distinctive groups of patients with AP: those newly diagnosed with AP without any previous CML treatment and those who progressed from previously treated CP, with the latter being more common and having worse survival Here, we present the results of our nationwide CML database analysis, focusing on the prognosis of patients fulfilling the criteria of AP CML at the time of their diagnosis. |
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