Blast Crisis (Blast Phase)

An advanced phase of chronic myelogenous leukemia, characterized by a rapid increase in the proportion of immature white blood cells (blasts) in the blood and bone marrow to greater than 30%.

Also Known As:

Networked: 1660 relevant articles (141 outcomes, 145 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	BCR-ABL Positive Chronic Myelogenous Leukemia (Chronic Myelogenous Leukemia)
2.	Leukemia
3.	Precursor Cell Lymphoblastic Leukemia-Lymphoma (Acute Lymphoblastic Leukemia)
4.	Acute Myeloid Leukemia (Acute Myelogenous Leukemia)
5.	Philadelphia Chromosome

Experts

1.	Cortes, Jorge: 30 articles (01/2021 - 05/2002)
2.	Hochhaus, Andreas: 26 articles (01/2020 - 05/2002)
3.	Kantarjian, Hagop: 23 articles (01/2021 - 10/2002)
4.	Kantarjian, Hagop M: 20 articles (06/2021 - 05/2002)
5.	Perrotti, Danilo: 19 articles (01/2022 - 01/2002)
6.	Cortes, Jorge E: 19 articles (12/2021 - 03/2006)
7.	Kim, Dong-Wook: 18 articles (11/2022 - 10/2004)
8.	Garcia-Manero, Guillermo: 17 articles (01/2021 - 05/2002)
9.	O'Brien, Susan: 17 articles (01/2020 - 05/2002)
10.	Jabbour, Elias: 15 articles (01/2021 - 01/2006)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Blast Crisis:

1.	Imatinib Mesylate (Gleevec)FDA Link 01/01/2012 - "While imatinib has been extremely effective for chronic phase CML, blast crisis CML are often resistant. " 05/01/2008 - "Imatinib mesylate (IM) is a new drug which has been shown to induce complete hematological remission in 55% and complete cytogenetic response in 22% of the patients with CML in blast crisis. " 06/01/2006 - "Extramedullary blast crises in CML patients in complete hematological remission treated with imatinib mesylate." 01/15/2006 - "Among 541 patients treated with imatinib in chronic phase, 23 developed blast phase, which was of sudden onset (ie, occurring in patients previously in complete cytogenetic remission) in 4 patients (17%; 0.7% of the total), 2 lymphoid and 2 myeloid. " 01/01/2016 - "NG-TKI-treated patients showed a significantly greater likelihood of MMR (relative risk [RR], 0.76; 95% confidence interval, 0.63-0.91; P = .003) and lower likelihood of progression to an accelerated phase/blast crisis (RR, 0.37; 95% confidence interval, 0.20-0.67; P = .001) than did imatinib-treated patients. "
2.	Tyrosine Kinase InhibitorsIBA 05/01/2020 - "In particular, the e6a2 fusion transcript has been associated with clinically aggressive disease frequently presenting in accelerated or blast crisis phases; there is limited evidence on the efficacy of front-line second-generation tyrosine kinase inhibitors for this genotype. " 09/01/2014 - "CML treatment with tyrosine kinase inhibitors (TKIs) has improved many patients' prognosis, but during the disease's terminal phase, the blast crisis (CML-BC), has been disappointing. " 01/01/2023 - "High BCR::ABL1 levels have been associated to proliferative advantage of leukemic cells, blast crisis progression and tyrosine kinase inhibitors (TKIs) inefficacy. " 01/01/2023 - "In the era of tyrosine kinase inhibitors (TKIs), CML patients now have a similar life expectancy to people without CML, and it is now very rare for CML patients to progress to the blast phase. " 12/09/2022 - "Chronic phase CML (CP-CML) patients who are resistant to 2 or more tyrosine kinase inhibitors (TKIs) have limited therapeutic options and are at significant risk for progression to the blast phase. "
3.	Dasatinib (BMS 354825)FDA Link 05/01/2016 - "Although extramedullary CNS blast crises are usually associated with a very poor outcome, our patient remains in complete cytogenetic and molecular remission, on single-agent dasatinib, 4 years after the diagnosis with no current evidence of active extramedullary disease. " 01/01/2015 - "Efficacy of Dasatinib in a CML Patient in Blast Crisis with F317L Mutation: A Case Report and Literature Review." 04/01/2011 - "Phase III dose-optimization study was performed to compare different regimens, stating that dasatinib 100 mg once daily is now the recommended schedule for patients with chronic CML, and 140 mg once daily for patients with accelerated phase or myeloid or lymphoid blast phase CML, and for patients with Ph+ ALL until progression. " 12/01/2008 - "In this international phase II trial, dasatinib was administered orally (70 mg twice daily) to patients with myeloid blast phase (MBP, n=109) or lymphoid blast phase (LBP, n=48) CML. " 01/01/2008 - "Major hematologic response rates with dasatinib were 63% in patients with accelerated phase CML (follow-up > or =9 months; START-A trial), 34% in patients with myeloid blast phase CML and 35% in those with lymphoid blast phase CML (follow-up > or =12 months; START-B and START-L trials), and 41% in patients with Ph-positive ALL (follow-up > or =12 months; START-L trial). "
4.	Cytarabine (Cytosar-U)FDA LinkGeneric 07/01/1986 - "We conclude that high-dose ara-C is an effective regimen for CML blast crisis, resulting in a substantial response rate but modest remission duration. " 01/01/1987 - "A Phase II study of high dose cytosine arabinoside (ara-C) with different schedules in patients with recurrent acute myelogenous leukaemia (AML) and myeloid blast crisis of chronic myeloid leukaemia has been conducted at St. Bartholomew's Hospital. " 06/01/2003 - "With a median follow-up of 14 months, a maximum follow-up of 19.5 months, and an expected median survival of 5-6 years on the IFN-alpha/cytarabine control arm, few of the expected progressions to accelerated or blast phase or deaths have occurred. " 11/01/1991 - "Its use in 5-day induction courses for blast crisis CML has a response rate comparable to that achieved with high-dose Ara-C. " 01/01/1988 - "The growth of CFU-L from peripheral blood of two patients with AML (M 2) and one patient with CML in blast crisis was differently influenced by Ara-C-application in vitro. "
5.	nilotinibFDA Link 01/01/2008 - "Data from the phase II trial in patients with CML in blast crisis (n = 135) also showed promising results, with 39% of patients achieving haematologic response with nilotinib. " 10/01/2010 - "Of 88 study patients (58 chronic, 11 accelerated, 19 blast crisis), the best responses to nilotinib were complete hematologic response (CHR) in 27%, partial cytogenetic response in 12%, complete cytogenetic response in 14%, and major molecular response in 19%. " 01/01/2008 - "Three of these arms, or phase II trials, evaluated nilotinib in each of the three phases of CML (chronic, accelerated or blast crisis).I n the phase II trial in patients with chronic-phase CML, major cytogenetic response (primary endpoint) was achieved in 48% of the 280 patients who received nilotinib and had a follow-up period of > or = 6 months. " 01/20/2023 - "Blast crisis with central nervous system leukemic involvement and K611N mutation of the SETD2 gene developed abruptly in the second patient five years after ceasing treatment with nilotinib in major molecular response (MMR) at the patient's request. " 03/01/2018 - "In this subgroup, one death occurred during treatment in the nilotinib 400-mg twice-daily arm (unknown cause), and one patient in each arm progressed to accelerated phase/blast crisis by the data cutoff."
6.	bcr-abl Fusion ProteinsIBA 12/01/2022 - "Resistance to BCR-ABL tyrosine kinase inhibitor (TKI) is the cause of treatment failure in blast phase chronic myeloid leukaemia (BP-CML). " 04/01/2015 - "Due to the high efficacy of BCR-ABL tyrosine kinase inhibition (TKI) in chronic phase (CP) chronic myeloid leukemia (CML), the frequency of blast crisis (BC) is greatly reduced compared to the pre-TKI era. " 09/01/2019 - "Despite the efficacy of BCR-ABL tyrosine kinase inhibitors (TKIs) in chronic phase-chronic myeloid leukemia, the management of blast phase-chronic myeloid leukemia (BP-CML) remains a challenge. " 01/01/2016 - "Despite BCR-ABL tyrosine kinase inhibitors (TKIs) improved outcome of patients with chronic myeloid leukemia (CML), resistance still develops when progresses to blast phase (BP). " 01/01/2016 - "Chronic myeloid leukemia (CML) responds well to BCR-ABL tyrosine kinase inhibitors (TKI), but becomes resistant to TKIs after it progresses to blast phase (BP). "
7.	Interferon-alpha (Interferon Alfa)IBA 04/15/1997 - "In a group of patients treated with alpha-interferon (n = 32), those with normal TRFs had a significantly lower frequency of blast crises (P = 0.0328), a significantly higher incidence of cytogenetic responses (P = 0.0185), and a favorable prognosis (P < 0.01) compared with those with shortened TRFs. " 08/01/2000 - "We report the previously undescribed occurrence of extramedullary blast crisis in a patient with chronic myelogenous leukemia in complete cytogenetic and molecular remission on interferon-alpha. " 01/01/2007 - "It is also indicated in paediatric patients with newly diagnosed Ph+ chronic-phase CML, in accelerated-phase or blast-crisis CML, or in chronic-phase CML after failure of interferon-alpha therapy or when the disease has recurred after haematopoietic stem cell transplantation (HSCT). " 08/01/2000 - "Extramedullary blast crisis in a patient with chronic myelogenous leukemia in complete cytogenetic and molecular remission on interferon-alpha therapy." 08/01/1993 - "Complete cytogenetic and molecular remission in a case of lymphoid blast crisis in chronic myeloid leukemia with intensive chemotherapy and interferon alpha."
8.	Hydroxyurea (Hydrea)FDA LinkGeneric 04/01/2002 - "We report a case of secondary Ph - ve MDS/AML during blast crisis in a patient treated with hydroxyurea for CML." 08/01/1999 - "The survival was longer for patients transplanted in accelerated phase (vs blast crisis), those who were due to receive a double transplant (vs single) (34 patients), those who were treated with IFN after transplant (vs hydroxyurea) and for the patients who obtained a complete hematologic response." 02/01/1993 - "In patient 2, although good control of the platelet counts was achieved with hydroxyurea, the disease also evolved into a blast crisis four months after diagnosis. " 09/15/1983 - "In 5 cases, treatment with hydroxyurea was successful in lowering circulating WBC counts, but was of questionable value in the prevention of leukemic blast crisis." 04/01/2002 - "After treatment with hydroxyurea for 7 months, the disease progressed to a blast crisis. "
9.	Busulfan (Busulfex)FDA Link 08/01/1999 - "Fifty-two other patients (group II) were transplanted for CML in transformation (accelerated phase = 32; blast crisis = 20) after a preparative regimen containing either total body irradiation (TBI) or busulfan. " 05/01/1991 - "Four weeks later, she passed into frank blast crisis, despite treatment with busulphan and palliative radiotherapy to the lymph nodes." 03/01/1992 - "Treatment with busulfan led to no improvement; instead in September 1986 he developed blast crisis with ANLL M4Eo morphology. " 01/01/1984 - "Busulfan had a pronounced cytoreductive effect on circulating leukemic cells in the late, pre-blast crisis stage of this disease but all treated animals, succumbed to the leukemia with only a marginal increase in survival time relative to that of untreated controls. " 10/01/1989 - "Lymphadenopathy regressed on busulphan therapy and the overt blast crisis took 15 months to occur after initial presentation."
10.	Vincristine (Oncovin)FDA LinkGeneric 04/01/1983 - "In vitro assay of the effects of vincristine on CFU-C appears to have predictive value for in vivo response in blast crisis of CGL." 04/01/1983 - "The in vitro sensitivity of circulating progenitor cells (CFU-C) of 20 patients in blast crisis of chronic granulocytic leukemia (CGL) to vincristine was correlated with the clinical response to vincristine in vivo. " 04/01/1983 - "The in vitro effects of vincristine on peripheral blood leukocyte progenitor cells (CFU-C) in patients in blast crisis of chronic granulocytic leukemia: correlation with clinical response." 01/01/1985 - "Although generally well tolerated, prolonged infusion of vincristine appears to have limited activity in the treatment of refractory acute nonlymphoblastic leukemia and blast crisis of chronic granulocytic leukemia; further evaluation is needed in acute lymphoblastic leukemia refractory to conventional bolus injection." 07/01/1990 - "In conclusion, combination use of vincristine and mithramycin may be useful in the treatment of the myeloid blast crisis."

Therapies and Procedures

1.	Therapeutics 01/01/2019 - "CML is diagnosed in accelerated (AP) or blast phase (BP) in <5% of patients, and the availability of effective treatments for chronic phase (CP) has dramatically reduced progressions on therapy. " 03/01/1991 - "The suppression of Ph1-positive hemopoiesis is a major goal in the treatment of CML; in this context the CML patients in blast crisis obtaining a complete clinical remission represent a useful model to investigate the behavior of the Ph1-positive and negative clones during bone marrow repopulation after ablative therapy. " 09/01/1987 - "Of 195 patients who received therapy for blast crisis, complete remission was achieved in 44 (23 percent) patients, and 24 (13 percent) patients had a partial remission or hematologic improvement. " 01/01/1994 - "Nevertheless, some patients under alpha-IFN therapy were found to develop lymphoid blast crisis despite high levels of NK and LAK activities, and partial or total cytogenetic remission. " 11/01/1981 - "The results of this study suggest that V-P therapy is more effective for CML blast crisis in childhood with TdT positive blast cells and that prophylactic central nervous system treatment is necessary to prevent meningeal leukaemia."
2.	Drug Therapy (Chemotherapy) 10/01/2002 - "Blast crisis recurred during subsequent intensification chemotherapy and the patient did not go into a complete remission regardless of the intense chemotherapy. " 04/01/2000 - "Often, however, the duration of chemotherapy-induced remission of blast crisis is very short and may preclude entry into a transplant program. " 03/01/1991 - "After a single cycle of induction, all lymphoid cases displayed a complete restoration of Ph1-negative hemopoiesis; by contrast, one myeloid blast crisis showed a partial suppression of Ph1-positive hemopoiesis only after two cycles of chemotherapy, and in the remaining two cases the hematological remission was indeed a reversion to the chronic phase. " 11/01/2018 - "High-dose systemic and intrathecal chemotherapy is safe and helpful for CCML extramedullary blast crisis. " 05/01/2005 - "Several doses of intrathecal chemotherapy and whole-brain irradiation were effective in treating the blast crisis in the CNS. "
3.	Hematopoietic Stem Cell Transplantation 10/06/2020 - "She was diagnosed with CML in blast phase, and was successfully treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT). " 01/01/2017 - "However, some CML patients, especially those in accelerated phase (AP) or blast phase (BP), require more aggressive forms of treatment such as allogenic hematopoietic stem cell transplantation. " 01/01/2008 - "HLA-mismatched/haploidentical hematopoietic stem cell transplantation without in vitro T cell depletion for chronic myeloid leukemia: improved outcomes in patients in accelerated phase and blast crisis phase." 04/01/2012 - "Successful management with an effective induction regimen followed by allogeneic hematopoietic stem cell transplantation for promyelocytic blast crisis of chronic myelogenous leukemia." 02/01/2003 - "The main obstacles to successful hematopoietic stem cell transplantation for patients with chronic myeloid leukemia (CML) in blast crisis (BC) are increased post-transplant relapse and high treatment-related mortality. "
4.	Stem Cell Transplantation 01/20/2023 - "The treatment outcome in patients with chronic myeloid leukaemia (CML) in blast crisis (BC) is unsatisfactory despite the use of allogeneic stem cell transplantation (ASCT). " 11/29/2018 - "Effective therapeutic options are limited for patients with Ph- MPNs in the blast phase (MPN-BP), and allogeneic stem-cell transplantation is the only known cure. " 02/23/2012 - "Patients in accelerated or blast crisis or who fail to reach landmarks on TKIs either because of intolerance or resistance should pursue stem cell transplantation. " 12/01/2006 - "A total of 69 patients were recruited with male/female ratio of 7:3. Of the 69 patients; 35% were in the chronic phase, 41% were in the accelerated phase, 17% were in blast crisis and the remaining 7% were after stem cell transplantation. " 01/19/2002 - "Subsequently the patient in blast crisis underwent allogeneic stem-cell transplantation. "
5.	Transplantation 01/01/2016 - "He also reviewed some of the therapeutic options in advanced disease, emphasizing that transplantation, although fraught with some difficulties, offers the best long-term prognosis for patients in blast crisis." 01/01/2016 - "For CML-blast crisis or chronic phase from blast crisis patients, HID transplantation achieves comparable survival to MRD transplantation. " 11/17/2011 - "Multivariate analysis identified only blast phase at transplantation (hazard ratio 3.68, P = .0011) and unrelated stem cell donor (hazard ratio 2.98, P = .011) as unfavorable factors. " 11/01/2010 - "At the time of transplantation, 7 patients (27%) were in first chronic phase (CP), 11 (42%) were in second CP, 2 (8%) were in accelerated phase (AP), and 6 (23%) were in blast crisis (BC). " 08/01/2008 - "At transplantation, the median patient age was 39 years (range, 1-67 years); 38 patients were in chronic phase (CP), 13 in the accelerated phase (AP) and 35 in blast crisis (BC). "