Criteria for the accelerated phase of CML (CML-AP) - one or more of the following:
(1) blasts comprise 10-19% of the white blood cells in the peripheral blood
(2) blasts comprise 10-19% of the nucleated cells in the bone marrow
(3) basophils comprise >= 20% of the white blood cells in the peripheral blood
(4) persistent thrombocytopenia (< 100,000 per µL) unrelated to therapy
(5) persistent thrombocytosis (> 1,000,000 per µL) unresponsive to therapy
(6) increasing size of the spleen and increasing white blood cell counts, unresponsive to therapy
(7) cytogenetic evidence of clonal evolution
Additional features suggestive of the accelerated phase - one of the following:
(1) bone marrow biopsy shows megakaryocytic proliferation (sheets or clusters) AND marked reticulin or collagen fibrosis AND severe granulocytic dysplasia
(2) bone marrow biopsy shows megakaryocytic proliferation (sheets or clusters) AND severe granulocytic dysplasia
Criteria for the blastic phase of CML (CML-BP) - one or more of the following:
(1) blasts comprise >=20% of the white blood cells in the peripheral blood
(2) blasts comprise >=20% of the nucleated cells in the bone marrow
(3) extramedullary blast proliferation
(4) large foci or clusters of blasts ("blast islands") in the bone marrow biopsy
