Blast crisis

Patients are monitored for hematologic response to tyrosine kinase inhibitor (TKI) therapy.

• Patients are seen weekly for 4 weeks, monitoring physical exam, complete blood count, and electrolytes for tumor lysis syndrome. Subsequently, they are seen for monthly blood counts.

• Cytogenetics (fluorescence in situ hybridization [FISH]) are rechecked every 3 months in the first year in peripheral blood, then every 6 to 12 months.

• Quantitative (real-time) polymerase chain reaction (qPCR) to detect the BCR::ABL1 transcript in peripheral blood is performed every 3 months after initiating treatment. If a BCR::ABL1 (International Scale [IS]) ≤1% is achieved, qPCR is done every 3 months for 2 years and every 3 to 6 months thereafter.[2]National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: chronic myeloid leukemia [internet publication]. https://www.nccn.org/guidelines/category_1 ​

• Quantitative PCR should be repeated in 1 to 3 months if there is a 1-log increase in BCR::ABL1 transcript levels with major molecular response.

Posttransplant, patients stay in the hospital until reconstitution occurs.

• Follow-up in the outpatient setting consists of blood counts, and FISH and qPCR to assess BCR::ABL1.

• Patients are usually seen monthly during the first year after transplant and until blood counts are stable. Subsequently, they are seen every 3 months.