Chronic myeloid leukemia, BCR-ABL1–positive

Diagnostic Criteria (WHO 2016)

  • Chronic Phase

    • Peripheral blood findings combined with detection of t(9;22)(q34.1;q11.2) or BCR-ABL1 by molecular genetic techniques
  • Accelerated phase

    • Any 1 or more of the following hematologic/cytogenetic criteria or response-to-TKI criteria
      • Hematologic/cytogenetic criteria
        • 10%-19% blasts in the peripheral blood and/or bone marrow.  The finding of bona fide lymphoblasts in the blood or marrow, even if  <10%, should prompt concern that lymphoblastic transformation may be imminent and warrants further clinical and genetic investigation
        • >20% basophils in the peripheral blood
        • Additional clonal chromosomal abnormalities in Ph1 cells at diagnosis that include “major route” abnormalities (second Ph, trisomy 8, isochromosome 17q, trisomy 19), complex karyotype, or abnormalities of 3q26.2
        • Persistent or increasing WBC (>10×109/L), unresponsive to therapy
        • Persistent thrombocytosis (>1000×109/L), unresponsive to therapy
        • Persistent thrombocytopenia (<100×109/L) unrelated to therapy
        • Any new clonal chromosomal abnormality in Ph1 cells that occurs during therapy
      • “Provisional” response-to-TKI criteria
        • Hematologic resistance to the first TKI (or failure to achieve a complete hematologic response* to the first TKI).  Complete hematologic response: WBC <10×109/L; platelet count <450×109/L, no immature granulocytes in the differential, and spleen nonpalpable
        • Any hematological, cytogenetic, or molecular indications of resistance to 2 sequential TKIs
        • Occurrence of 2 or more mutations in BCR-ABL1 during TKI therapy
      • Large clusters or sheets of small, abnormal megakaryocytes, associated with marked reticulin or collagen fibrosis in biopsy specimens may be considered as presumptive evidence of AP, although these findings are usually associated with 1 or more of the criteria listed above.
  • Blast Phase

    • >20% blasts in the blood or bone marrow
    • Presence of an extramedullary accumulation of blasts


Clinical Features

Laboratory Testing



Treatment and Prognosis


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