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: 1213 relevant articles (110 outcomes, 116 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: 23 articles (10/2015 - 05/2002)
2.	Hochhaus, Andreas: 20 articles (05/2013 - 05/2002)
3.	Kantarjian, Hagop: 16 articles (03/2014 - 10/2002)
4.	Perrotti, Danilo: 15 articles (10/2013 - 01/2002)
5.	Kantarjian, Hagop M: 14 articles (10/2015 - 05/2002)
6.	O'Brien, Susan: 13 articles (11/2014 - 05/2002)
7.	Hochhaus, A: 12 articles (11/2013 - 01/2001)
8.	Saglio, Giuseppe: 11 articles (05/2013 - 03/2003)
9.	Calabretta, Bruno: 11 articles (09/2008 - 01/2002)
10.	Kim, Dong-Wook: 10 articles (09/2015 - 10/2004)

Drugs and Biologics

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

1.	imatinib (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. " 03/01/2010 - "Imatinib was shown to be effective in patients with molecular or hematologic relapse of chronic or accelerated phase posttransplant (CP, AP), whereas outcomes in blast phase were more unfavorable. "
2.	dasatinib (BMS 354825)FDA Link 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). " 12/01/2012 - "Before starting dasatinib three patients were in chronic phase of CML while seven others were in the progressive phase (accelerated and blast phase) of CML. "
3.	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. " 11/01/1993 - "The cytotoxic potency of Aza-dC was comparable or even greater than that of 1-beta-D-arabinofuranosylcytosine (Ara-C) in most cases, suggesting that this drug has potential in the therapy of blast crisis of CML. " 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. "
4.	Interferon-alpha (Interferon Alfa)FDA Link 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. " 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). " 10/01/1996 - "The model was sensitive to the monthly cost of interferon-alpha therapy (if the cost of interferon-alpha is reduced by one third, the cost-effectiveness becomes $19300 per quality-adjusted year of life saved) but was not particularly sensitive to the costs associated with blast crisis or bone marrow transplantation. " 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. " 08/01/2000 - "Extramedullary blast crisis in a patient with chronic myelogenous leukemia in complete cytogenetic and molecular remission on interferon-alpha therapy."
5.	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." 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. " 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." 09/01/2004 - "A 53-year-old obese African American woman weighing 136 kg (ideal body weight [IBW] 55 kg) with new-onset chronic myelomonocytic leukemia in leukocytic blast crisis was treated with hydroxyurea 5 g daily. "
6.	Protein-Tyrosine Kinases (Tyrosine Kinase)IBA 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. " 12/01/2015 - "A closer investigation of the influence of Ras-mediated signaling pathways on CML progression to blast crisis is warranted to uncover new directions for targeted therapies, particularly in cases that are resistant to current tyrosine kinase inhibitors." 10/13/2015 - "Given p53's ability to modulate the expression and activity of Bcl-2 family members, we hypothesized that targeting Bcr-Abl, Bcl-2, and p53 concomitantly could have therapeutic benefits in blast crisis (BC) CML and in quiescent CML CD34+ cells that are insensitive to tyrosine kinase inhibitors (TKI). " 11/01/2014 - "Tyrosine kinase inhibitors (TKIs) have been shown to induce favorable response rates in patients with accelerated and blast phase CML. " 09/01/2014 - "Allogeneic hematopoietic SCT in combination with tyrosine kinase inhibitor treatment compared with TKI treatment alone in CML blast crisis."
7.	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." 01/01/1988 - "The response to uniform vincristine and prednisolone (V + P) therapy has shown that lymphoid blast crisis cases were highly responsive in contrast to the cases with non-lymphoid blast crisis (complete remission rate 86 vs 21.4%). "
8.	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. " 10/01/1989 - "Lymphadenopathy regressed on busulphan therapy and the overt blast crisis took 15 months to occur after initial presentation." 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. "
9.	Prednisone (Sone)FDA LinkGeneric 12/01/1984 - "[Phase II study of the treatment of CML blast crisis with vindesine and prednisone]." 12/01/1989 - "The NK lymphocyte blast crisis was successfully treated with vincristine and prednisone. " 06/01/1989 - "These results were compared to a historical control group of 31 patients with myeloid blast crisis treated with vincristine and prednisone. " 06/30/1982 - "Five of 40 patients with chronic myeloid leukemia (CML) had lymphoid blast crisis and 4 of them achieved complete remission of metamorphosis with vincristine and prednisone. " 02/01/1994 - "Thus, a remission was seen during treatment with vincristine, prednisone, and MPA after a deterioration with vincristine and prednisone alone in a PR-positive leukemia, and an effect of MPA in this lymphoid blast crisis of a CML has to be discussed."
10.	4- methyl- N- (3- (4- methylimidazol- 1- yl)- 5- (trifluoromethyl)phenyl)- 3- ((4- pyridin- 3- ylpyrimidin- 2- yl)amino)benzamide (nilotinib)FDA 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. " 06/17/2010 - "Patients receiving either the 300-mg dose or the 400-mg dose of nilotinib twice daily had a significant improvement in the time to progression to the accelerated phase or blast crisis, as compared with those receiving imatinib (P=0.01 and P=0.004, respectively). " 06/01/2015 - "Because the probable diagnosis was the blast crisis of CML, we switched from nilotinib to dasatinib. "

Therapies and Procedures

1.	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. " 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. " 05/01/2005 - "Several doses of intrathecal chemotherapy and whole-brain irradiation were effective in treating the blast crisis in the CNS. " 11/01/2014 - "The addition of TKIs to chemotherapy has also been associated with improved outcomes in patients with blast phase CML. " 01/01/1984 - "The median survival, the rate of decline in survival, and the remission rate in blast crisis do not appear to differ from those of comparable groups of patients treated with chemotherapy alone."
2.	Transplants (Transplant) 02/01/2005 - "The study population comprised 647 (60%) males and 437 (40%) females, with a median age of 32 years old (range 1 - 59); 898 (83%) were in chronic phase, 146 (13%) were in accelerated phase and 40 (4%) were in blast crisis; 151 (14%) were younger than 20 years old, 620 (57%) were between 20 and 40 and 313 (29%) were older than 40; 1,025 (94%) received an HLA fully matched sibling transplant and only 59 (6%) received an unrelated transplant. " 01/01/2013 - "Prior to transplant, confirmatory typing performed on PB revealed two full haplotypes at Class I and II. Sample identification error and the presence of third party lymphocyte engraftment as a result of prior red cell or granulocyte transfusion(s) were ruled out by STR analysis of 8 loci of all samples, T and B cells from cryopreserved PB at blast crisis were HLA typed independently. " 06/01/2011 - "Allogeneic hematopoietic transplants have the best chance to be curative in patients with chronic phase that is under hematologic control with 80% disease-free survival; patients progressing to the accelerated phase or blast crisis have a much poorer prognosis. " 02/01/2011 - "The 28 cases of CML in accelerated phase or blast crisis received allo-HSCT were analysed retrospectively in terms curative efficacy, basic characteristics before transplant and prognosis, therapeutic strategy before transplant and prognosis, events after transplant and prognosis. " 04/01/2001 - "At transplant, six patients were in chronic phase (five in first, and one in second), two in blast crisis, and one in accelerated phase. "
3.	Transplantation (Transplant Recipients) 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). " 03/01/2006 - "Successful cord blood transplantation in a minor BCR-ABL+ CML patient who had been in lymphoid blast crisis at presentation." 04/01/2005 - "The patient who underwent transplantation in blast crisis died on day 21 (too early to be evaluated for engraftment) from progressive disease. "
4.	Bone Marrow Transplantation (Transplantation, Bone Marrow) 07/01/1998 - "Response did allow one patient to proceed to bone marrow transplantation and two other patients to continue therapy for chronic phase disease before returning to blast crisis. " 01/01/1994 - "Seven patients were in first chronic phase and the other 3 were in blast crisis, second chronic phase, and relapse post-bone marrow transplantation (BMT), respectively. " 10/01/1992 - "A 47-year-old patient was treated with allogeneic bone marrow transplantation (BMT) for chronic myelogenous leukaemia in blast crisis. " 07/01/1992 - "Relapse into blast crisis following bone marrow transplantation for chronic phase chronic myeloid leukaemia: a report of five cases." 01/08/1988 - "Since at present there are no reliable risk factors for the occurrence of acceleration or blast crisis, bone marrow transplantation should be undertaken as early as possible in the chronic phase of CML."
5.	Stem Cell Transplantation 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. " 09/01/1997 - "Autologous stem cell transplantation was performed, but relapse occurred 11 months after blast crisis. " 09/01/2012 - "Allogeneic stem cell transplantation for myeloproliferative neoplasm in blast phase."