prognosis of CML

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Median survival is 4-6 years (can range from less than 1 year to more than 10 years)

  • however occasionally patients die within a few months
  • 3% of patients live more than 15 years without radical therapy
  • once the accelerated phase  is reached survival is usually less than 1 year and in the blast phase, few patients survive more than a few months (1).

It is important to identify the prognostic factors at diagnosis. The following can be used to provide useful prognostic information in a patient with CML:

  • accurate identification of the disease stage (or phase) is considered to be the essential factor
  • clinical and laboratory features - used to calculate prognostic scores (Sokal score or Hasford score)
    • these scores identifies patients with low, intermediate, and high risk of short term survival
  • cytogenetic changes e.g. - deletions of the derivative chromosome 9
    • Imatinib can be used to partly overcome the negative prognostic effects of this
    • but the size and location of the deletion appears to be important
  • degree and timing of haematological, cytogenetic, and molecular responses (2)

Approximately 60% of young adults with successful allogeneic bone marrow transplantation are cured.

Studies have revealed that the following features are predictive of a shorter chronic phase:

  • increased splenomegaly.
  • older age
    • chronic myeloid leukaemia mortality is strongly related to age, with the highest mortality rates being in older people. In the UK in 2014-2016, on average each year two-thirds (66%) of deaths were in people aged 75 and over
      • largely reflects higher incidence and lower survival for chronic myeloid leukaemia in older people
      • age-specific mortality rates rise steeply from around age 60-64. The highest rates are in the 90+ age group for males and females
      • mortality rates are similar between males and females in most age groups
  • male gender
  • elevated serum lactate dehydrogenase.
  • cytogenetic abnormalities in addition to the Ph1.
  • a higher proportion of marrow or peripheral blood blasts.
  • basophilia.
  • eosinophilia.
  • thrombocytosis.
  • anaemia (1)

Reference:

Last edited 05/2019 and last reviewed 05/2019

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