Skip to main content
SpringerLink
Log in

Blast crisis of Philadelphia chromosome-positive chronic myelocytic leukemia (CML)

Treatment results of 69 patients

  • Original Articles
  • Published:
Blut Aims and scope Submit manuscript

Summary

We have studied the clinical courses of 69 patients with blastic crises of Philadelphia chromosome positive CML to identify parameters that were associated with an increased response rate or survival. Cytogenetic analysis at the time of blastic transformation revealed additional chromosome changes in 70% of the patients tested. Bone marrow fibrosis was detected in 58% of evaluable patients. Lymphoblastic transformation was seen in 28% of the patients tested with cell surface marker analysis. The value of 5'-nucleotidase as a marker for distinguishing lymphoid from non-lymphoid blast crisis was confirmed. Of 57 evaluable patients, 23 (40%) responded to therapy (CR/PR longer than 14 days). Median survival was 75 days. Longer survival was related to the following factors: Ph1-chromosome as the only detectable cytogenetic abnormality; lymphoblastic transformation; no bone marrow fibrosis; high percentage of blasts and promyelocytes in the bone marrow, and response to therapy. No prognostic significance was associated with age, sex, Tdt, LDH, spleen size, duration of the chronic phase of the disease, white blood cell count, Hb, platelet count and percentages of basophils, eosinophils, erythroblasts and blasts and promyelocytes in the peripheral blood. These data confirm the poor prognosis of patients with blastic crisis of CML treated by conventional chemotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Alimena G, De Cuia MR, Diverio D, Gastaldi R, Nanni M (1987) The karyotype of blastic crisis. Cancer Genet Cytogenet 26: 39–50

    Google Scholar 

  2. Bacigalupo A, Frassoni F, Van Lint MT et al. (1986) Bone marrow transplantation for chronic granulocytic leukemia. Cancer 58: 2307–2311

    Google Scholar 

  3. Bartram CR, de Klein A, Hagemeijer A, van Agthoven T, Geurts von Kessel A, Bootsma D, Grosveld G, Ferguson-Smith MA, Davies T, Stone M, Heisterkamp N, Stephenson JR, Groffen J (1983) Translocation of c-abl oncogene correlates with the presence of a Philadelphia chromosome in chronic myelocytic leukemia. Nature 306: 277–280

    Google Scholar 

  4. Batram CR, Raghavachar An, Anger B, Stain C, Bettelheim P (1987) T-lymphocytes lack rearrangement of the ber gene in Philadelphia chromosome positive chronic myelocytic leukemia. Blood 69: 1682–1685

    Google Scholar 

  5. Canellos G, DeVita VT, Whang-Peng J, Carbonne PP (1971) Hematologic and cytogenic remission of blast transformation in chronic granulocytic leukemia. Blood 38: 671–679

    Google Scholar 

  6. Coleman M, Silver R, Pajak T, Cavalli F, Rai KR, Kostinas JE, Glidewell O, Holland JF (1980) Combination chemotherapy for terminal phase chronic myelocytic leukemia. Blood 55: 29–36

    Google Scholar 

  7. Cunningham I, Gee T, Dowling M, Chaganti R, Bailey R, Hopfan S, Bowden L, Turnbull A, Knapper W, Clarkson B (1979) Results of treatment of ph′ + chronic myelogenous leukemia with an intensive treatment regimen (L-5 protocol). Blood 53: 375–395

    Google Scholar 

  8. Desforges JF, Miller KB (1986) Blast crisis — reversing the direction. N Engl J Med 315: 1478–1479

    Google Scholar 

  9. Fialkow PJ, Jacobson RJ, Papayannopoulou T (1977) Chronic myelocytic leukemia: clonal origin in a stem cell common to granulocyte, erythrocyte, platelet and monocyte/macrophage. Am J Med 63: 125–130

    Google Scholar 

  10. Goldman JM, Apperley JF, Jones L et al. (1986) Bone marrow transplantation for patients with chronic myeloid leukemia. N Engl J Med 314: 202–207

    Google Scholar 

  11. Groffen J, Stephenson JR, Heisterkamp N, Klein A de, Bartram CR, Grosveld G (1984) Philadelphia chromosomal breakpoints are clustered within a limited region, bcr, on chromosome 22. Cell 36: 93–99

    Google Scholar 

  12. Gutensohn W, Thiel E (1981) High levels of 5'-Nucleotidase activity in blastic chronic myelogenous leukemia with common ALL-antigen. Leukemia Res 5: 505–510

    Google Scholar 

  13. Janossy G, Greaves MF, Revesz T, Lister TA, Roberts M, Durrant J, Kirk B, Catovsky D, Beard ME (1976) Blast crisis of chronic myeloid leukemia (CML). II. Cell surface marker analysis of ‘lymphoid’ and myeloid cases. Br J Haematol 34: 179–192

    Google Scholar 

  14. Kantarjian HM, Vellekopu L, McCredie KB, Keating MJ, Hester J, Smith T, Barlogie B, Trujillo J, Freireich EJ (1985) Intensive combination chemotherapy (ROAP 10) and splenectomy in the management of chronic myelogenous leukemia. J Clin Oncol 3: 192–200

    Google Scholar 

  15. Koeffler HP, Golde DW (1981) Chronic myelogenous leukemia — new concepts. N Engl J Med 304: 1201–1209, 1269–1274

    Google Scholar 

  16. Koller CA, Miller DM (1986) Preliminary observations on the therapy of the myeloid blast phase of chronic granulocytic leukemia with plicamycin and hydroxyurea. N Engl J Med 315: 1433–1438

    Google Scholar 

  17. Marks SM, Baltimore D, McCaffrey R (1978) Terminal transferase as a predictor of initial responsiveness to vincristine and prednisone in blastic chronic myelogenous leukemia: a co-operative study. N Engl J Med 298: 812–814

    Google Scholar 

  18. Maxwell SA, Kurzrock R, Parsons SJ, Talpaz M, Grallick GE, Kloetzer WS, Arlinghaus RB, Kouttab NM, Keating NJ, Gutterman JU (1987) Analysis of P210 bcr-abl tyrosine protein kinase activity in various subtypes of Philadelphia chromosome-positive cells from chronic myelogenous leukemia patients. Cancer Res 47: 1731–1739

    Google Scholar 

  19. Reiffers J, Gorin NC, Michallet M, Maraninchi D, Herve P (1986) Autografting for chronic granulocytic leukemia in transformation. JNCI 76: 1307–1310

    Google Scholar 

  20. Rosenthal S, Canellos GP, DeVita VT, Gralnick HR (1977) Characteristics of blast crisis in chronic granulocytic leukemia. Blood 49: 705–714

    Google Scholar 

  21. Rosenthal S, Canellos G, Whang-Peng J, Gradwick A (1977) Blast crisis of chronic granulocytic leukemia. Am J Med 63: 542–547

    Google Scholar 

  22. Rowley JD (1973) A new consistent chromosomal abnormality in chronic myelogenous leukaemia identified by quinacrine fluorescence and Giemsa staining. Nature 243: 290–293

    Google Scholar 

  23. Schiffer CA, DeBellis R, Kasdorf H, Wiernik Ph (1982) Treatment of the blast crisis of chronic myelogenous leukemia with 5-Azacitidine and VP-16-213. Cancer Treat Rep 66: 267–271

    Google Scholar 

  24. Sokal JE, Baccarani M, Tura S et al. (1985) Prognostic discriminiation among younger patients with chronic granulocytic leukemia: relevance to bone marrow transplantation. Blood 66: 1352–1357

    Google Scholar 

  25. Talpaz M, Kantarjian HM, McCredie KB, Keating MJ, Trujillo J, Gutterman J (1987) Clinical investigation of human alpha interferon in chronic myelogenous leukemia. Blood 69: 1280–1288

    Google Scholar 

  26. Thomas ED, Clift RA, Fefer A et al. (1986) Marrow transplantation for the treatment of chronic myelogenous leukemia. Ann Intern Med 104: 155–163

    Google Scholar 

  27. Vallejos CS, Trujillo JM, Cork A,. Bodey GP, McCredie KB, Freireich EJ (1974) Blastic crisis in chronic granulocytic leukemia: experience in 39 patients. Cancer 34: 1806–1812

    Google Scholar 

  28. Winton EF, Miller D, Vogler WR (1981) Intensive chemotherapy with Daunorubicin, 5-Azacytidine, 6-Thioguanine and Cytarabine (DATA) for the blastic transformation of chronic granulocytic leukemia. Cancer Treat Rep 64: 389–392

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine III (Hematology/Oncology), D-7900, Ulm, Federal Republic of Germany

    B. Anger, I. Braunger & H. Heimpel

  2. Department of Clinical Physiology, University of Ulm, Steinhövelstrasse 9, D-7900, Ulm, Federal Republic of Germany

    F. Carbonell & B. Heinze

  3. Department of Hematology/Oncology, University of München, Ziemssenstrasse 1, D-8000, München, Federal Republic of Germany

    E. Thiel

  4. Department of Anthropology and Human Genetics, University of München, Goethestrasse 31, D-8000, München, Federal Republic of Germany

    W. Gutensohn

Authors
  1. B. Anger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Carbonell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. Braunger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Heinze
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. Gutensohn
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. Thiel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. H. Heimpel
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Anger, B., Carbonell, F., Braunger, I. et al. Blast crisis of Philadelphia chromosome-positive chronic myelocytic leukemia (CML). Blut 57, 131–137 (1988). https://doi.org/10.1007/BF00320153

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00320153

Key words

Search

Navigation