Chronic Myelogenous Leukemia (CML) Staging

Updated: Aug 24, 2020
  • Author: Sandy D Kotiah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Phases of Chronic Myelogenous Leukemia

Unlike most cancers, chronic myelogenous leukemia (CML) is classified into phases rather than stages, based partly on the percentage of immature white blood cells (blasts) in peripheral blood and bone marrow. A complete blood count with differential, peripheral blood smear, and bone marrow analysis are used to determine the phase. The 3 phases of CML, as defined by the World Health Organization (WHO), [1, 2] are listed below.

Table. Phases of Chronic Myelogenous Leukemia (Open Table in a new window)

CML phase

WHO definition

Chronic stable phase

Blasts < 10% in peripheral blood and bone marrow

Accelerated phase

  • Blasts comprising 10-19% of white blood cells (WBCs) in peripheral blood and/or nucleated bone marrow cells
  • Peripheral blood myeloblasts and promyelocytes combined ≥30%
  • Peripheral blood basophils ≥20%
  • Persistent thrombocytopenia (< 100 × 10 9/L) unrelated to therapy or persistent thrombocytosis (> 1000 × 10 9/L) unresponsive to therapy
  • Increasing WBC counts and spleen size unresponsive to therapy
  • Additional clonal cytogenetic abnormalities in Philadelphia chromosome–positive cells

Blast crisis

  • Blasts ≥ 20% of peripheral blood WBCs or nucleated bone marrow cells
  • Extramedullary blast proliferation
  • Large foci or clusters of blasts on bone marrow biopsy

In addition, the prognosis for patients with CML can be calculated by using risk scores. See the Sokal Score for CML and Calculation of Relative Risk of CML Patients

See also Chronic Leukemias: 4 Cancers to Differentiate, a Critical Images slideshow, to help detect chronic leukemias and determine the specific type present.


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