Prognosis

Prognosis for patients with blast crisis is poor, particularly for patients with progression from chronic phase chronic myeloid leukaemia (CML) or with myeloid phenotype blast crisis.

For patients undergoing allogeneic haematopoietic stem cell transplant (HSCT), long-term survival and mortality depend on age, disease status at transplant, and donor type.[69][70][71]

Median overall survival of approximately 12 months was reported in one retrospective chart review of patients with CML in blast crisis (n=477; blast phase defined as ≥30% blasts or extramedullary disease; 199-2016 data) who were treated (at The University of Texas MD Anderson Cancer Center) with a tyrosine kinase inhibitor at some point during the course of their disease.[7]​ The study found that 5-year survival was significantly lower among patients with myeloid blast phase compared with lymphoid blast phase (P <0.001; 15% vs. 30%).[7]​

Data from a large European blast phase registry (n=240; blast phase defined as ≥20% blasts or extramedullary disease; 2015-2023 data) reported a median overall survival of 23.8 months (median follow-up 27.8 months).[6]​ The majority of patients (>80%) received a TKI; 55% underwent at least one HSCT for their blast phase. Patients with de novo blast crisis had a better outcome than those with progression from chronic phase CML; median survival 29.7 months versus 18.0 months, respectively. Lymphoid phenotype blast crisis (n=71) was associated with improved survival compared with myeloid blast crisis (n=117); median survival 32.2 months versus 17.0 months, respectively.[6]

Retrospective review of 147 HSCT patients with advanced-phase CML (median age 39 years; 81.5% received pre-transplant TKI; transplanted in Germany or Russia) reported overall survival of 34% at 15 years.[71]

One Japanese registry study reported 5-year overall survival rates of 82.8% (chronic phase at diagnosis; n=124), 71.1% (accelerated phase at diagnosis; n=23), and 73.3% (blast phase at diagnosis; n=53) for HSCT patients (<30 years; n=200) who received pre-transplant tyrosine kinase inhibitor (TKI) therapy.[70]

In one phase 1/2 multicentre dose-finding trial of ponatinib in combination with a fludarabine-containing chemotherapy regimen (FLAG-IDA), median overall survival in patients with blast-phase CML (median age 33 years) receiving allogeneic HSCT had not been reached (7 [58%] of 12 alive with a median follow-up of 36 months).[42]

Use of this content is subject to our disclaimer