The prognosis in chronic myelogenous leukemia (CML) can be estimated by using the simple synthesis prognostic staging system of Kantarjian et al. The system is intended to be easily applied in clinical practice.
Patient selection:
(1) CML with less than 30% blasts in the bone marrow and peripheral blood
(2) presence of Philadelphia chromosome
(3) no history of prior chemotherapy or minimal prior chemotherapy
Parameters:
(1) age
(2) splenic size
(3) differential count of peripheral blood
(4) differential count of bone marrow
(5) platelet count
(6) cytogenetics
Group A Findings
Points
age >= 60
1
spleen >= 10 cm below costal margin
1
blasts >= 3% in blood OR >= 5% in bone marrow
1
basophils >= 7% in blood OR >= 3% in bone marrow
1
platelet count >= 700,000 per µL
1
group A score =
= SUM(Group A findings present)
Group B Findings
Points
cytogenetic clonal evolution
1
blasts >= 15% in blood
1
blasts + promyelocytes >= 30% in blood
1
basophils >= 20% in blood
1
platelet count < 100,000 per µL
1
where:
• cytogenetic clonal evolution consists of chromosomal abnormalities in addition to the Philadelphia chromosome; it does not include Ph-like chromosomal abnormalities or complex translocations involving chromosomes 9 and 22.
group B score =
= SUM(Group B findings present)
Determining Stage
Group B Score
Group A Score
Stage
>= 1
NA
4
0
>= 3
3
0
2
2
0
0 or 1
1
Estimating Prognosis from Stage
Stage
median survival in months
1
56
2
45
3
30
4
30
Estimated Survival Percentage
Stage
1 year
2 years
4 years
1
94
87
62
2
94
78
46
3
91
68
25
4
71
57
25
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