Accelerated phase chronic myeloid leukemia: evaluation of clinical criteria as predictors of survival, major cytogenetic response and progression to blast phase

• Published in: Revista brasileira de hematologia e hemoterapia Vol. 37; no. 5; pp. 341 - 347
• Main Authors: Furtado, Vanessa Fiorini, Santos, Gustavo Rengel, de Carvalho, Denise Siqueira, Staziaki, Pedro Vinícius, Pasquini, Ricardo, Funke, Vaneuza Araújo Moreira
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier Editora Ltda 01.09.2015; Sociedade Brasileira de Hematologia e Hemoterapia; Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular; Elsevier
• Subjects: Accelerated phase; Chronic myeloid leukemia; HEMATOLOGY; Imatinib; MEDICINE, RESEARCH & EXPERIMENTAL; Mortality; Original; Prognostic factor; Prognostic factor; Accelerated phase; Imatinib; Chronic myeloid leukemia; Mortality
• ISSN: 1516-8484; 1806-0870; 1806-0870
• DOI: 10.1016/j.bjhh.2015.07.004

Published criteria defining the accelerated phase in chronic myeloid leukemia are heterogeneous and little is known about predictors of poor outcome. This is a retrospective study of 139 subjects in the accelerated phase of chronic myeloid leukemia treated with imatinib at a single center in Brazil. The objective was to identify risk factors for survival, major cytogenetic response and progression to blast phase in this population. The factors analyzed were: blasts 10–29%, basophils≥20%, platelets>1×106/μL or <1×105/μL and white blood cells>1×105/μL in the peripheral blood, as well as clonal evolution, splenomegaly, hemoglobin<10g/dL, time between diagnosis of chronic myeloid leukemia and imatinib treatment, and hematologic toxicity. Risk factors for poor survival in multivariate analysis were Grades 3–4 hematologic toxicity (p-value=0.001), blasts 10–29% (p-value=0.023), and hemoglobin<10g/dL (p-value=0.04). Risk factors for not achieving major cytogenetic response were blasts 10–29% (p-value=0.007), hemoglobin<10g/dL (p-value=0.001), and previous use of interferon (p-value=0.032). Risk factors for progression to the blast phase were hemoglobin<10g/dL (p-value=0.005), basophils≥20% (p-value=0.023), and time from diagnosis of chronic myeloid leukemia to imatinib treatment>12 months (p-value=0.030). These data indicate that patients with the above risk factors have a worse prognosis. This information can guide the therapy to be used.