Maisonneuve-Rosemont Hospital Université de Montréal

Chronic myeloid leukemia

Prognostic scores

  1. Sokal :
    • Age
    • Splenomegaly
    • White cell count
    • Platelet count
    To calculate the Sokal score:
    < .8 : low risk
    .8-1.2 : intermediate risk
    > 1.2 : high risk
  2. Hasford :
    0.6666 X age (0 if < 50, 1 if ≥ 50)
    +
    0.0420 X spleen (cms BCM)
    +
    0.0584 X % blasts PB
    +
    0.0413 X % eosinophils PB
    +
    0.2039 X basophils (0 if < 3%, 1 if ≥ 3%)
    +
    0.0956 X platelets (0 if < 1500, 1 if ≥ 1500)
    X 1000
Score Median survival
Low risk ≤780 96 months
Int > 780 and ≤1480 65 months
High > 1480 42 months

Definitions of accelerated and blastic phases

Criteria used by the ISIS study and retained by the Canadian consensus group

  1. Accelerated phase
    • Blasts 15-29% in blood or marrow
    • Blasts + promyelocytes ≥ 30% in blood or marrow
    • Basophils ≥ 20% in blood
    • Thrombocytopenia < 100 x 109/L unrelated to therapy
    • Clonal evolution
  2. Blastic phase
    • Blasts ≥ 30% in blood or marrow
    • Extramedullary involvement (example: chloroma but excluding hepatosplenomegaly)

Transplantation: Risk assessment

Type of donor Score
HLA-ID Other
0 1

Status of disease Score
CP 0
AP 1
BP 2
Age Score
< years old 0
20-40 1
> 40 2

Mismatch sex Score
Female donor, male recipient 1
Other combination 0

Interval between diagnosis and transplant Score
< 12 months 0
> 12 months 1

Risk factors (%) TRM (%) 5 year survival
0-1 20 70
2 30 60
3 50 50
4 55 35
5-7 70 25

Objectives to achieve on imatinib

Definition of progressive disease while on imatinib therapy

Eligibility criteria for allogeneic transplant in 1st chronic phase

There are therapeutic alternatives to transplantation in patients who progress, who do not achieve the desired objectives while on imatinib or who are intolerant to imatinib: ↑ dose imatinib, 2nd generation kinase inhibitors. A 2nd generation kinase inhibitor should be strongly considered in a patient who is intolerant to imatinib before considering transplantation.

Eligibility criteria for allogeneic transplant in accelerated phase

The patient is automatically eligible. It is recommended to treat the patient initially with imatinib (600 mg QD) pre transplant to try and obtain a cytogenetic response. There is likely an outcome benefit if the patient is in cytogenetic remission at the time of transplant.

Eligibility criteria for allogeneic transplant in blast crisis

We do not perform transplant in blast crisis. The patient must be back in accelerated or chronic phase to be eligible.

Age criteria for transplant