Health Professionals / Chronic myeloid leukemia
Chronic myeloid leukemia
Prognostic scores
- Sokal :
- Age
- Splenomegaly
- White cell count
- Platelet count
To calculate the Sokal score:
< .8 : low risk
.8-1.2 : intermediate risk
> 1.2 : high risk
- Hasford :
0.6666 X age (0 if < 50, 1 if ≥ 50)
+
0.0420 X spleen (cms BCM)
+
0.0584 X % blasts PB
+
0.0413 X % eosinophils PB
+
0.2039 X basophils (0 if < 3%, 1 if ≥ 3%)
+
0.0956 X platelets (0 if < 1500, 1 if ≥ 1500)
X 1000
| Score |
Median survival |
| Low risk ≤780 |
96 months |
| Int > 780 and ≤1480 |
65 months |
| High > 1480 |
42 months |
Definitions of accelerated and blastic phases
Criteria used by the ISIS study and retained by the Canadian consensus group
- Accelerated phase
- Blasts 15-29% in blood or marrow
- Blasts + promyelocytes ≥ 30% in blood or marrow
- Basophils ≥ 20% in blood
- Thrombocytopenia < 100 x 109/L unrelated to therapy
- Clonal evolution
- Blastic phase
- Blasts ≥ 30% in blood or marrow
- Extramedullary involvement (example: chloroma but excluding hepatosplenomegaly)
Transplantation: Risk assessment
| Type of donor |
Score |
| HLA-ID |
Other |
| 0 |
1 |
| Status of disease |
Score |
| CP |
0 |
| AP |
1 |
| BP |
2 |
| Age |
Score |
| < years old |
0 |
| 20-40 |
1 |
| > 40 |
2 |
| Mismatch sex |
Score |
| Female donor, male recipient |
1 |
| Other combination |
0 |
| Interval between diagnosis and transplant |
Score |
| < 12 months |
0 |
| > 12 months |
1 |
| Risk factors |
(%) TRM |
(%) 5 year survival |
| 0-1 |
20 |
70 |
| 2 |
30 |
60 |
| 3 |
50 |
50 |
| 4 |
55 |
35 |
| 5-7 |
70 |
25 |
Objectives to achieve on imatinib
- 3 months: complete hematologic remission
blood: WBC < 10, plt < 450, < 5% myelocytes+metamyelocytes, < 20% basophils, absence of blasts and promyelocytes
< 20% basophile, absence de blaste et promyélocyte
- 6 months: major cytogenetic response (<35%)
- 12 months: complete cytogenetic remission
- 18 months: major molecular response (>3 logs reduction bcr-abl)
Definition of progressive disease while on imatinib therapy
- Progression from chronic to accelerated phase
- Clonal evolution in Ph+ cells
- Loss of complete cytogenetic remission
- Confirmed increase of ≥ 0.5 log (Q-PCR) in patients in complete cytogenetic remission
- Presence of a mutation in the abl kinase domain
Eligibility criteria for allogeneic transplant in 1st chronic phase
- Without imatinib trial: usually not recommended but would be considered if the patient has a clear preference and if he/she clearly understands the associated risks of transplantation
- Patient on imatinib: therapeutic objectives not achieved, intolerance to imatinib or progressive disease
- Objectifs thérapeutiques non atteints (voir section IV)
- Intolérance à l’imatinib
- Progression (voir section V)
There are therapeutic alternatives to transplantation in patients who progress, who do not achieve the desired objectives while on imatinib or who are intolerant to imatinib: ↑ dose imatinib, 2nd generation kinase inhibitors. A 2nd generation kinase inhibitor should be strongly considered in a patient who is intolerant to imatinib before considering transplantation.
Eligibility criteria for allogeneic transplant in accelerated phase
The patient is automatically eligible. It is recommended to treat the patient initially with imatinib (600 mg QD) pre transplant to try and obtain a cytogenetic response. There is likely an outcome benefit if the patient is in cytogenetic remission at the time of transplant.
Eligibility criteria for allogeneic transplant in blast crisis
We do not perform transplant in blast crisis. The patient must be back in accelerated or chronic phase to be eligible.
Age criteria for transplant
- Related or unrelated myeloablative transplant: until 60 years old
- Related nonmyeloablative transplant: until 65 years old
- Unrelated nonmyeloablative transplant: until 60 years old
