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Cancer Staging Systems

Staging of Chronic Myeloid Leukemia (CML)

Phases of CML

Chronic phase

Less than 5% blasts and promyelocytes in the peripheral blood and bone marrow.

Accelerated phase

Greater than 5% blasts in either the peripheral blood or the bone marrow but less than 30% in both the peripheral blood and bone marrow.

Blastic phase

Greater than 30% blasts in the peripheral blood or bone marrow.

The annual rate of progression from chronic phase to blast crisis is 5% to 10% in the first 2 years and 20% in subsequent years.

Relapsed CML

Relapsed chronic myelogenous leukemia is characterized by any evidence of progression of disease from a stable remission. This may include the following:

• Increasing myeloid or blast cells in the peripheral blood or bone marrow.
• Cytogenetic positivity when previously cytogenetic-negative.
• FISH positivity for BCR/ABL (breakpoint cluster region/Abelson) translocation when previously FISH-negative.

Detection of the BCR/ABL translocation by RT–PCR during prolonged remissions does not constitute relapse on its own.

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