| Abstract: |
This chapter addresses blast crisis, the final phase of chronic myeloid leukemia (CML) in which the majority of patients are diagnosed in a chronic phase. The most prevalent phenotype of blast-phase CML is the evolution of chronic-or accelerated-phase CML, which is resistant to therapy and manifests as a clonal disease bearing ABL kinase domain mutations 50% or more of the time. Therapy for cases of blast crisis of CML is quite dependent on the clinical and prior treatment history, and treatment is aimed at prevention of a penultimate accelerated phase or blast crisis. As a general axiom, transplantation should be part of the discussion of most cases of blast crisis CML. Disease control may be longer in a minority of patients, but durable remission after tyrosine kinase inhibitor (TKI) therapy, TKI plus chemotherapy, or conventional chemotherapy in the setting of blast crisis is the exception and not the rule. Ponatinib, the first approved "third-generation" kinase inhibitor, continues in clinical trials now as initial therapy for new-diagnosis chronic-phase CML. © 2014 John Wiley and Sons, Inc. |
