{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T04:18:43Z","timestamp":1788236323476,"version":"build-2803163510"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2003,5,16]],"date-time":"2003-05-16T00:00:00Z","timestamp":1053043200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2003,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Therapeutic options in Philadelphia chromosome\u2010positive chronic myelogenous leukemia (Ph\u2010positive CML) in chronic phase include allogeneic stem cell transplantation (SCT) and treatments other than allogeneic SCT. The choice of therapy often depends on the mortality risk of allogeneic SCT. Delaying SCT until the disease demonstrates resistance to other strategies (e.g., imatinib mesylate or interferon\u2010\u03b1) entails the risk of the development of a sudden blastic phase, which may not permit enough time to perform a SCT.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The current study was performed to define the incidence and patterns of sudden\u2010onset blastic\u2010phase CML in relation to the risk inherent in delaying allogeneic SCT. Of a study group of 1286 patients who were referred in early chronic\u2010phase CML between 1981\u20132001 and who received therapies other than allogeneic SCT, 1093 patients had regular follow\u2010up at the study institution. A sudden onset of blastic phase was defined as having its onset within 3 months from a previously documented complete hematologic response.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Among the 1093 patients, 183 patients developed blastic\u2010phase disease, which was of sudden onset in 46 patients (25%; 4% of the total). The incidence of sudden blastic phase was 0.4% in the first year, 1.8% in the second year, and 2.6% in the third year. Patients with sudden blastic\u2010phase disease were found to have more often low\u2010risk features at the time of presentation, including low incidences of blasts and thrombocytosis. Sudden blastic\u2010phase CML was found to be associated with a higher incidence of lymphoid blastic morphology (67% vs. 22%; <jats:italic>P<\/jats:italic> &lt; 0.0001), which resulted in a higher response rate to blastic\u2010phase therapy (70% vs. 29%; <jats:italic>P<\/jats:italic> &lt; 0.0001) and significantly longer survival from the onset of blastic\u2010phase disease (median of 12 months vs. 6 months; <jats:italic>P<\/jats:italic> &lt; 0.01). Twenty\u2010four of the 42 patients with sudden blastic\u2010phase disease who were treated at the M. D. Anderson Cancer Center were able to undergo allogeneic SCT in second chronic phrase (<jats:italic>n<\/jats:italic> = 13) or transformed phase (<jats:italic>n<\/jats:italic> = 11); at the time of last follow\u2010up, 6 patients were alive without evidence of disease at a median of 18 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The low rates of sudden blastic transformation in the first 3 years of the course of disease for CML and the salvage rate of these patients with allogeneic SCT should be considered in relation to the transplantation mortality in patients with early chronic\u2010phase disease and the early promising results with imatinib mesylate therapy. Cancer 2003;98:81\u20135. \u00a9 2003 American Cancer Society.<\/jats:p><jats:p>DOI 10.1002\/cncr.11477<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.11477","type":"journal-article","created":{"date-parts":[[2003,6,23]],"date-time":"2003-06-23T12:15:02Z","timestamp":1056370502000},"page":"81-85","source":"Crossref","is-referenced-by-count":46,"title":["Sudden onset of the blastic phase of chronic myelogenous leukemia"],"prefix":"10.1002","volume":"98","author":[{"given":"Hagop","family":"Kantarjian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"O'Brien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Cortes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Giles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Kornblau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianquin","family":"Shan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Beth Rios","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Keating","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emil","family":"Freireich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moshe","family":"Talpaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2003,5,16]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-131-3-199908030-00008"},{"key":"e_1_2_5_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199907153410306"},{"key":"e_1_2_5_4_2","first-page":"1517","article-title":"An evidence\u2010based analysis of the effect of busulfan, hydroxyurea, interferon, and allogeneic bone marrow transplantation in treating the chronic phase of chronic myeloid leukemia: developed for the American Society of Hematology","volume":"94","author":"Silver RT","year":"1999","journal-title":"Blood."},{"key":"e_1_2_5_5_2","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1182\/blood.V82.7.2235.2235","article-title":"Choice of pretransplant treatment and timing of transplants for chronic myelogenous leukemia in chronic phase","volume":"82","author":"Goldman M","year":"1993","journal-title":"Blood."},{"key":"e_1_2_5_6_2","first-page":"509","article-title":"Bone marrow transplantation for chronic myeloid leukemia: long\u2010term results. Chronic Leukemia Working Party of the European Group for Bone Marrow Transplantation","volume":"12","author":"Gratwohl A","year":"1993","journal-title":"Bone Marrow Transplant."},{"key":"e_1_2_5_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)03030-X"},{"key":"e_1_2_5_8_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-122-4-199502150-00003"},{"key":"e_1_2_5_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(95)92596-1"},{"key":"e_1_2_5_10_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1999.17.1.284"},{"key":"e_1_2_5_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199707243370402"},{"key":"e_1_2_5_12_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V99.5.1527"},{"key":"e_1_2_5_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200104053441401"},{"key":"e_1_2_5_14_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa011573"},{"key":"e_1_2_5_15_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V93.12.4149"},{"key":"e_1_2_5_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(20001015)89:8<1647::AID-CNCR1>3.0.CO;2-U"},{"key":"e_1_2_5_17_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V98.7.2039"},{"key":"e_1_2_5_18_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1998.16.9.2897"},{"key":"e_1_2_5_19_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V82.3.691.691"},{"key":"e_1_2_5_20_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V87.8.3069.bloodjournal8783069"},{"key":"e_1_2_5_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(87)90754-6"},{"key":"e_1_2_5_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(93)90122-6"},{"key":"e_1_2_5_23_2","first-page":"S1","article-title":"Marrow transplantation for CML: the Seattle experience","volume":"17","author":"Clift RA","year":"1996","journal-title":"Bone Marrow Transplant."},{"key":"e_1_2_5_24_2","first-page":"94a","article-title":"Survival after allogeneic bone marrow transplantation in patients randomized into a trial of IFN alpha versus chemotherapy: no significant adverse effect of prolonged IFN alpha administration","volume":"86","author":"Shepherd P","year":"1995","journal-title":"Blood."},{"key":"e_1_2_5_25_2","first-page":"410","article-title":"Effect of short\u2010term interferon therapy on the outcome of subsequent HLA\u2010identical sibling bone marrow transplantation for chronic myelogenous leukemia: an analysis from the international bone marrow transplant registry","volume":"95","author":"Giralt S","year":"2000","journal-title":"Blood."}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fcncr.11477","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.11477","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T14:26:24Z","timestamp":1760279184000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.11477"}},"subtitle":["<i>Patterns and implications<\/i>"],"short-title":[],"issued":{"date-parts":[[2003,5,16]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2003,7]]}},"alternative-id":["10.1002\/cncr.11477"],"URL":"https:\/\/doi.org\/10.1002\/cncr.11477","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"value":"0008-543X","type":"print"},{"value":"1097-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2003,5,16]]}}}