Staging
Staging is a method that doctors use to determine the baseline situation of cancer in a patient, how advanced it is, and the best course of treatment. Doctors commonly divide CML into three "phases" depending on the number (percentage) of blast cells in your blood and bone marrow.
Chronic Phase
Description
- There are less than 15% blasts in the blood and bone marrow. You may have fairly mild symptoms. Most people with CML are diagnosed in the chronic phase. Chronic phase CML usually responds well to standard treatment.
Treatment
- Treatment of chronic phase is essentially based on targeted therapy with the tyrosine kinase inhibitors such as imatinib, nilotinib, dasatinib, bosutinib, ponatinib, and asciminib. Dasatinib, bosutinib, nilotinib, and ponatinib and asciminib are are approved for second and third lines of therapy. Ponatinib and asciminib are effective against the gape-keep mutation T3151. Omacetaxine is approved for patients who failed at least 2 TKIs.
Accelerated Phase
Description
- There are between 15% and 30% blasts in the blood and bone marrow. You may have symptoms such as fatigue, fever, weight loss, and loss of appetite. Some subtypes of accelerated phase CML does not respond as well to treatment.
Treatment
- In this phase you may receive any of the same treatments used in chronic phase. Your doctor may also recommend combining targeted therapy with stem cell transplantation or biological therapy with chemotherapy. You may also be given a blood transfusion.
Blast Phase
Description
- There are over 30% blasts in the blood and bone marrow. Blast phase CML behaves more like an acute leukemia and progresses rapidly. It often spreads to tissues and organs outside of the bone marrow and may cause severe symptoms (blast crisis).
Treatment
- In this phase you may receive targeted therapy, chemotherapy, high-dose chemotherapy with stem cell transplant, palliative treatments or clinical trials.
