A. Blasts 10-19% of WBC’s in peripheral blood
B. Basophils 10-19% of WBC’S in peripheral blood
C. Increasing spleen size unresponsive to therapy
D. Persistent thrombocytosis (>1000 x 109/L) unresponsive to therapy
Answer is D (Persistent thrombocytosis > 1000 x 109/L positive to therapy)
Accelerated phase is associated with thrombocytopenia (9/L) and not thrombocytosis.
Although multivariate analysis derived criteria also place blood or marrow basophils > 20% in disease criteria, other criteria do consider marrow and peripheral basophils > 10% as a criteria and hence option (D) is the single best answer here.
Accelerated phase of CML: It is defined by the development of increasing degrees of anemia unaccounted for by bleeding or chemotherapy and is defined by several criteria.
|Multivariate analysis derived criteria||Other commonly used criteria|
|Cytogenetic clonal evolution|
|Blood or marrow blasts between 10 and 20%||Increasing drug dosage requirement|
|Blood or marrow basophils > 20%||Marrow reticulum or collagen fibrosis|
|Platelet count < 100 x 10°/L unrelated to therapy||Marrow or peripheral blasts > 10%|
|Marrow or peripheral basophils eosinophils – 10% Triad of WBC > 50 x 109/L, haematocrit < 25% and Mai,100 liP/L not controlled ii1111 therapy Unexplained fever or bone pain|