Translate page

× To share and enhance best practice management of CML, experts and interested clinicians can discuss difficult or interesting CML cases here. Physicians submit a brief history of the patient and the case for discussion (no more than 200 words) by posting it in this forum ("New Discussion" button below). Please include the country of origin.

Each clinical case will be forwarded to the expert clinical panel for a brief independent response. Consideration should be given to patient confidentiality. Details that are not critical to the case can be changed to preserve anonymity. Please consider including your email with the case. This will not be posted on the website, but is useful should further details be requested by the moderator.

As a full clinical history is necessary for accurate comment, cases and comments on the Forum are ONLY ACCEPTED FROM PHYSICIANS. If individual patients have a specific question we encourage them to contact their healthcare provider. General questions can be emailed to

DISCLAIMER: The iCMLf does not recommend or endorse any specific tests, physicians, products, procedures, or opinions, and disclaims any representation, warranty, or guaranty as to the same. Reliance on any information provided in this Forum is solely at your own risk.

Blast crisis with immature double population

3 years 1 week ago - 3 years 1 day ago #1832 by marianna.lima
Male patient, 42 years old, diagnosed with CML (positive BCR / ABL), in the diagnosis presented in bone marrow immunophenotyping two populations of blasts: t lymphoid populations (0.45%) + myeloblasts (1.34%) totaling 1.78 immature cells). Description of grade 3 fibrosis. Treatment initiated with imatinib.

It evolved with the appearance of multiple tumors and showed granulocytic sarcoma.

Questions :

In treatment, ITK Dasatinib should be associated with which systemic chemotherapy. Should I opt for chemotherapy directed at the myeloid component (7 + 3) or T lymphoid (HyperCVAD) or both (FLAG-IDA?

When choosing therapy, should we consider grade 3 bone marrow fibrosis?

There's a new bone marrow evaluation schedule with immunophenotyping that we still don't have the result for. In evaluating possible donors for ongoing transplants.
Last edit: 3 years 1 day ago by arlene.
  • Andreas Hochhaus
  • Andreas Hochhaus's Avatar
3 years 1 day ago - 3 years 1 day ago #1833 by Andreas Hochhaus
Replied by Andreas Hochhaus on topic Blast crisis with immature double population
I would resist to apply a full dose combination chemotherapy. Recovery of normal hematopoiesis is impossible in CML and the whole treatment aims to prepare for transplant.

Therefore, Dasatinib 100 mg/d should be the start, combined with an individually dosed chemotherapy with Ara-C and a intermediate dose of an anthracyclin.

A full dosed 7+3 or similar will result in long lasting cytopenias and may be disadvantageous.

With some more information about timing (diagnosis until myeloid sarcoma, histology of the lesions (% blasts), BCR-ABL mutations, cytogenetics) I would be happy to provide more detailed advice if you would like me to.
Last edit: 3 years 1 day ago by arlene.
Moderators: Nicolaarlene