Chronic myeloid leukaemia, accelerated and blast phase
Chronic myeloid leukaemia can accelerate and then transform into an acute leukaemia called blast crisis. Tyrosine kinase inhibitors are given at full strength, combined with acute leukaemia chemotherapy in blast phase, to bring the disease back to chronic phase quickly enough for a donor stem cell transplant, the only treatment that cures it.
Overview
Accelerated phase is defined by 10 to 19 percent blasts in blood or marrow (WHO; the ELN and ICC use 15 to 29 percent and additional criteria), basophils of 20 percent or more, thrombocytopenia unrelated to treatment, or new clonal chromosomal abnormalities on top of the Philadelphia chromosome; the ICC 2022 classification folds most accelerated-phase features into high-risk chronic phase. Blast phase is 20 percent or more blasts (30 percent by ELN) or an extramedullary blast proliferation, and is myeloid in two thirds and lymphoid in a third. Additional mutations in ASXL1, RUNX1, IKZF1 and TP53 accumulate with progression, and resistance mutations in the BCR::ABL1 kinase domain are common.
Treatment aims to return the disease to a second chronic phase and consolidate with allogeneic transplant, the only curative treatment. In accelerated phase a second- or third-generation inhibitor at the higher dose, chosen by mutation testing (ponatinib for T315I, asciminib in trials), can restore a chronic phase lasting years, and transplant is reserved for poor responders. In blast phase the inhibitor is combined with acute leukaemia induction: 7+3-type chemotherapy for myeloid blast phase, or ALL-type regimens, or blinatumomab and inotuzumab for lymphoid blast phase, where dasatinib and ponatinib are favoured for their activity in the central nervous system. Patients who reach transplant in a second chronic phase have long-term survival in a substantial minority; those transplanted in overt blast phase rarely do.
Progression is now rare enough that trials are small and outcomes come from registries (the CML-IV and ELN blast phase studies). Prevention through early achievement of molecular milestones and prompt switching on failure is the practical strategy, and the biology of the leukaemic stem cell that acquires these extra hits is the research question.
State of the art
- Tyrosine kinase inhibitors have made progression rare: around one percent of chronic-phase patients a year.
- Blast phase is treated as an acute leukaemia with an inhibitor added, and cured only by transplant in a second chronic phase.
- Third-generation inhibitors cover T315I in advanced phase, and chemotherapy-free inhibitor-plus-antibody regimens are being borrowed from Philadelphia-positive ALL.
Red cards
From the labels and guidelines behind the standard of care. Your team's thresholds win.- Emergency services nowFainting or palpitations
Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
- Emergency services nowBleeding or bruising
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
- Emergency services nowBlood clot (lenalidomide, pomalidomide, thalidomide)
A swollen painful calf, or sudden breathlessness with chest pain; venous and arterial thromboembolism is a boxed warning and blood-thinning prophylaxis is recommended.
- Emergency services nowCytokine release syndrome
Fever of 38 C or higher, chills, low blood pressure, fast heartbeat or breathlessness, especially after a step-up dose. Boxed warning on teclistamab, epcoritamab, glofitamab, tarlatamab and blinatumomab.
- Emergency services nowTumour lysis syndrome
Nausea, vomiting, muscle cramps, palpitations, seizures, confusion or passing much less urine in the first days of a new dose; the label requires hydration, anti-hyperuricaemic drugs and blood tests around each ramp-up step.
- Check before combiningDasatinib with Nilotinib: major interaction
QT: both Dasatinib and Nilotinib prolong the QT interval (known and known risk).. Avoid other QT-prolonging drugs where possible; check ECG and correct potassium and magnesium before and during treatment.
See all on the product pages:AsciminibAzacitidineBlinatumomabBosutinibCyclophosphamideCytarabineCytarabine + anthracycline ('7+3')DasatinibNilotinibOlverembatinibPonatinibVenetoclax·Printable cards in the navigator
Anatomy and lymph node drainage
- Bone marrow (leukaemia, MDS, MPN, myeloma)
- Lymph node germinal centre (lymphomas)
- Spleen
- Blood (leukaemic phase)
- Lytic bone lesions (myeloma)
- Skin and extranodal sites
- Nodes: cervical
- Nodes: axillary
- Nodes: mediastinal
- Nodes: para-aortic and mesenteric
- Nodes: inguinal
Leukaemias, myeloma and MDS live in the marrow and blood; lymphomas grow in lymph nodes and spleen. The node stations are the disease map, not a route of spread, and staging counts them.
- Bone marrow (leukaemia, MDS, MPN, myeloma)Accelerated phase CML (10 to 19 percent blasts, basophilia or clonal evolution) · Myeloid blast phase CML · Lymphoid blast phase CML (dasatinib or ponatinib with ALL-type therapy) · De novo blast phase at presentation · Extramedullary blast phase (myeloid sarcoma) · Second chronic phase after treatment of blast phase (transplant candidate)
- Lymph node germinal centre (lymphomas)
- Spleen
- Blood (leukaemic phase)
- Lytic bone lesions (myeloma)Extramedullary blast phase (myeloid sarcoma)
- Skin and extranodal sites
- cervical
- axillary
- mediastinal
- para-aortic and mesenteric
- inguinal
In lymphoma the node stations are the disease itself; staging (Ann Arbor / Lugano) counts how many regions and sides of the diaphragm are involved.
Same organ: Marginal zone lymphoma, Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome), Primary mediastinal (thymic) large B-cell lymphoma, Leukaemia (all types), Acute myeloid leukaemia, Acute lymphoblastic leukaemia, Chronic lymphocytic leukaemia, Chronic myeloid leukaemia (CML), Diffuse large B-cell lymphoma, Follicular lymphoma, Hodgkin lymphoma, Mantle cell lymphoma, Multiple myeloma, Non-Hodgkin lymphoma (all types), Myelodysplastic syndromes / neoplasms (MDS), Myeloproliferative neoplasms (PV, ET, myelofibrosis), Polycythaemia vera (PV), Essential thrombocythaemia (ET), Waldenström macroglobulinaemia, Hairy cell leukaemia, Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma), Blastic plasmacytoid dendritic cell neoplasm (BPDCN), Burkitt lymphoma, HIV-associated (AIDS-related) lymphomas, Chronic myelomonocytic leukaemia and MDS/MPN overlap neoplasms, Systemic mastocytosis, Erdheim-Chester disease, Rosai-Dorfman disease and other histiocytic neoplasms, Langerhans cell histiocytosis (LCH), Post-transplant lymphoproliferative disorder (PTLD), FLT3-mutated acute myeloid leukaemia, IDH1- and IDH2-mutated acute myeloid leukaemia, NPM1-mutated and KMT2A-rearranged acute myeloid leukaemia, Secondary and therapy-related acute myeloid leukaemia, Acute promyelocytic leukaemia, Acute myeloid leukaemia in older or unfit patients, Smouldering multiple myeloma, Newly diagnosed multiple myeloma, transplant-eligible, Newly diagnosed multiple myeloma, transplant-ineligible, Relapsed or refractory multiple myeloma, Plasma cell leukaemia, Lower-risk myelodysplastic syndromes, Higher-risk myelodysplastic syndromes, Chronic lymphocytic leukaemia, first treatment, Relapsed or refractory chronic lymphocytic leukaemia, Richter transformation of chronic lymphocytic leukaemia, Chronic myeloid leukaemia, chronic phase, Primary myelofibrosis
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- Fewer than one in twenty patients now present in accelerated or blast phase, and progression from chronic phase on treatment has fallen to around one percent a year; blast phase remains the most dangerous form of the disease, with survival historically under a year.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Second- or third-generation tyrosine kinase inhibitor at full dose guided by mutation testing (dasatinib, nilotinib, bosutinib, ponatinib for T315I, olverembatinib where approved); allogeneic transplant if response is poor or clonal evolution progresses.
Tyrosine kinase inhibitor (ponatinib or dasatinib) with 7+3-type or hypomethylating agent and venetoclax induction, then allogeneic transplant in second chronic phase.
Dasatinib or ponatinib with ALL-type chemotherapy or with blinatumomab, central nervous system prophylaxis, then allogeneic transplant.
Allogeneic stem cell transplant for every eligible patient in second chronic phase, with tyrosine kinase inhibitor maintenance after transplant.
Subtypes & biomarkers
top- Accelerated phase CML (10 to 19 percent blasts, basophilia or clonal evolution)
- Myeloid blast phase CML
- Lymphoid blast phase CML (dasatinib or ponatinib with ALL-type therapy)
- De novo blast phase at presentation
- Extramedullary blast phase (myeloid sarcoma)
- Second chronic phase after treatment of blast phase (transplant candidate)
- Blast percentage in blood and marrow
- Basophil percentage and platelet count
- Additional chromosomal abnormalities (clonal evolution)
- BCR ::ABL1 kinase domain mutations including T315I
- Blast lineage by flow cytometry (myeloid or lymphoid)
- ASXL1, RUNX1, IKZF1 and TP53 mutations
- Donor availability
How often this target appears
- 1980Blast crisis defined; median survival months with chemotherapy
- 2001Imatinib produces responses in blast phase, though short-lived
- 2012Ponatinib approved for advanced phase including T315I
- 2021Olverembatinib approved in China for T315I chronic and accelerated phase
- 2022ICC and WHO redefine accelerated and blast phase thresholds
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 6 changes by month →- 2026-09-17This recordChronic myeloid leukaemia, accelerated and blast phaseFacts on this page last checked
When this page itself was last checked or edited.
- 2022MilestoneChronic myeloid leukaemia, accelerated and blast phaseICC and WHO redefine accelerated and blast phase thresholds
A milestone in how this cancer is treated.
- 2021MilestoneOlverembatinibOlverembatinib approved in China for T315I chronic and accelerated phase
A milestone in how this cancer is treated.
- 2012MilestonePonatinibPonatinib approved for advanced phase including T315I
A milestone in how this cancer is treated.
- 2001MilestoneImatinibImatinib produces responses in blast phase, though short-lived
A milestone in how this cancer is treated.
- 1980MilestoneBlasts (leukaemic blast cells)Blast crisis defined; median survival months with chemotherapy
A milestone in how this cancer is treated.
What is in development for Chronic myeloid leukaemia, accelerated and blast phase, drawn from the whole corpus: 3 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Trials under way · 2
- The Study for CML Who Failed Prior TKIs or With T315I Mutation or Ph+ ALL Who Failed Prior TKIs or With T315I Mutation · phase 2 · Otsuka Beijing Research Institute
- Open-label Study of Asciminib for CML-CP or CML-AP Patients With T315I Mutation Who Are Resistant, Intolerant or Ineligible to Ponatinib. · phase 2 · Novartis Pharmaceuticals
Combinations being explored · 1
Open problems and what is being done
Blast phase remains largely fatal without transplant, and few patients reach it in remission.
Trials are tiny because progression has become rare.
The mutations that drive progression are known but not targetable.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Landmark trials
Expert centres
topExpert centres
Seoul · hospital | South Korea | none recorded | 0 | 448 | 2,611 | - | |
Los Angeles, CA · cancer center | United States | 0 | 318 | 3,917 | - | ||
Melbourne · research institute | Australia | none recorded | 0 | 298 | 3,639 | - | |
Indianapolis, IN · cancer center | United States | 0 | 159 | 4,238 | - | ||
Hamilton, ON · cancer center | Canada | none recorded | 0 | 103 | 1,158 | - | |
Baltimore, MD · cancer center | United States | 0 | 101 | 2,306 | - | ||
Portland, OR · cancer center | United States | 0 | 62 | 620 | - | ||
Omaha, NE · cancer center | United States | 0 | 37 | 4,159 | - | ||
Monrovia, CA · consortium | United States | none recorded | 0 | 20 | 186 | none recorded | - |
Philadelphia, PA · consortium | United States | none recorded | 0 | 15 | 142 | - | |
Rotterdam · consortium | Netherlands | none recorded | 0 | 8 | 207 | - | |
New Delhi · government | India | none recorded | 0 | not matched | - | - | |
Rome · consortium | Italy | none recorded | 0 | not matched | - | - | |
Minneapolis, MN · cancer center | United States | 0 | not matched | - | - |
These are the things we can measure; they are not a ranking of quality. Each column is a field on the institution record or a count over what OnCo has linked; a centre that treats many patients with Chronic myeloid leukaemia, accelerated and blast phase but is thinly recorded here will look small.
Not known: OnCo holds no case-volume or outcome figures for centres, so none are shown. Where a national audit or registry publishes them, the centre's page links to it. Default order: Newsweek rank, then trials for this cancer, then research output.
Questions to ask
topQuestions to ask your oncologist about Chronic myeloid leukaemia, accelerated and blast phase
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Blast percentage in blood and marrow, Basophil percentage and platelet count, Additional chromosomal abnormalities, BCR::ABL1 kinase domain mutations including T315I, Blast lineage by flow cytometry), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Accelerated phase CML, Myeloid blast phase CML, Lymphoid blast phase CML.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Accelerated phase
- For my situation (accelerated phase), which of the standard options do you recommend and why?Why: Guideline options include: Second- or third-generation tyrosine kinase inhibitor at full dose guided by mutation testing (dasatinib, nilotinib, bosutinib, ponatinib for T315I, olverembatinib where approved); allogeneic transplant if response is poor or clonal evolution progresses.
- Am I a candidate for Dasatinib, Nilotinib, Bosutinib or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of The Study for CML Who Failed Prior TKIs or With T315I Mutation or Ph+ ALL Who Failed Prior TKIs or With T315I Mutation and Open-label Study of Asciminib for CML-CP or CML-AP Patients With T315I Mutation Who Are Resistant, Intolerant or Ineligible to Ponatinib. apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Myeloid blast phase
- For my situation (myeloid blast phase), which of the standard options do you recommend and why?Why: Guideline options include: Tyrosine kinase inhibitor (ponatinib or dasatinib) with 7+3-type or hypomethylating agent and venetoclax induction, then allogeneic transplant in second chronic phase.
- Am I a candidate for Ponatinib, Dasatinib, Cytarabine + anthracycline ('7+3') or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Lymphoid blast phase
- For my situation (lymphoid blast phase), which of the standard options do you recommend and why?Why: Guideline options include: Dasatinib or ponatinib with ALL-type chemotherapy or with blinatumomab, central nervous system prophylaxis, then allogeneic transplant.
- Am I a candidate for Dasatinib, Ponatinib, Blinatumomab or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Consolidation
- For my situation (consolidation), which of the standard options do you recommend and why?Why: Guideline options include: Allogeneic stem cell transplant for every eligible patient in second chronic phase, with tyrosine kinase inhibitor maintenance after transplant.
Any stage
- Are there clinical trials I could join, for example of Ponatinib, Asciminib, Olverembatinib, Blinatumomab?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Blast phase remains largely fatal without transplant, and few patients reach it in remission”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Trials are tiny because progression has become rare”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Newly diagnosed? Read the first 60 days with Chronic myeloid leukaemia, accelerated and blast phase, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
8targets
6drugs
13companies
8pathways
1terms
6trials
2pairings
1Latest papers
topQuery for this cancer: (TITLE:"Chronic myeloid leukaemia, accelerated and blast phase" OR ABSTRACT:"Chronic myeloid leukaemia, accelerated and blast phase" OR TITLE:"CML-AP" OR ABSTRACT:"CML-AP" OR TITLE:"CML-BP" OR ABSTRACT:"CML-BP" OR TITLE:"Blast crisis" OR ABSTRACT:"Blast crisis" OR TITLE:"Advanced-phase CML" OR ABSTRACT:"Advanced-phase CML" OR TITLE:"Accelerated-phase CML" OR ABSTRACT:"Accelerated-phase CML") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Chronic myeloid leukaemia, accelerated and blast phase, not a curated reading list.
Similar pages
not linked directly; found by shared links- CancerChronic myeloid leukaemia, chronic phase
Shares Olverembatinib, Philadelphia chromosome (Ph+, BCR::ABL1), Bosutinib, Nilotinib and the tag subtype-page.
- CancerFLT3-mutated acute myeloid leukaemia
Shares Cytarabine + anthracycline ('7+3'), Allogeneic stem cell transplantation, Azacitidine, Venetoclax and the tag subtype-page.
- CancerHigher-risk myelodysplastic syndromes
Shares Conditioning regimen (myeloablative, reduced-intensity), Allogeneic stem cell transplant (allo-SCT), Allogeneic stem cell transplantation, Azacitidine and the tag subtype-page.
- CancerIDH1- and IDH2-mutated acute myeloid leukaemia
Shares Cytarabine + anthracycline ('7+3'), Allogeneic stem cell transplantation, Azacitidine, Venetoclax and the tag subtype-page.
- CancerAcute myeloid leukaemia in older or unfit patients
Shares Cytarabine, Cytarabine + anthracycline ('7+3'), Allogeneic stem cell transplantation, Azacitidine and the tag subtype-page.
- CancerNPM1-mutated and KMT2A-rearranged acute myeloid leukaemia
Shares Cytarabine + anthracycline ('7+3'), Allogeneic stem cell transplantation, Azacitidine, Venetoclax and the tag subtype-page.
- CancerSecondary and therapy-related acute myeloid leukaemia
Shares Cytarabine + anthracycline ('7+3'), Allogeneic stem cell transplantation, Azacitidine, Venetoclax and the tag subtype-page.
- CancerPrimary myelofibrosis
Shares Conditioning regimen (myeloablative, reduced-intensity), Allogeneic stem cell transplant (allo-SCT), Allogeneic stem cell transplantation, Small-molecule kinase inhibitors and the tag subtype-page.