CML in Blast Phase: What to Do When Prior Chemotherapy and TKI Did Not Regain Chronic Phase

Clinical Scenario

This protocol addresses chronic myeloid leukemia in blast phase — defined by 20% or more blasts in the peripheral blood or bone marrow, or extramedullary blast proliferation — after the initial blast-phase regimen has not achieved its goal.

Why This Step Is Reached

The preceding line used intensive combination chemotherapy with a TKI (dasatinib or ponatinib preferred), or low-intensity chemotherapy with a TKI for patients not suitable for intensive treatment. The target of that line — regaining a second chronic phase — was not reached, prompting escalation to this protocol.

Next-Step Approach (Partial)

The approach at this stage involves a transplant-based intervention, timed around disease-state requirements that must be met before it can proceed. Full sequencing, eligibility criteria, and coordination details are in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1038/s41375-025-02664-w

In 2022 the WHO revised the classification of disease phase in CML, omitting the concept of AP, and defining BP as the presence of >20% blasts.
Treatment for eligible patients in BP is by intensive combination chemotherapy with a TKI, ideally dasatinib or ponatinib, followed by alloSCT.
Every possible effort should be made to regain a second chronic phase and offer alloSCT promptly thereafter.

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