CML

Question 1

Define AP-CML (NCCN v3 2025)

Answer 1

Modified MDACC Criteria1,2
• Peripheral blood myeloblasts ≥15% and <30%
• Peripheral blood myeloblasts and promyelocytes combined ≥30%
• Peripheral blood basophils ≥20%
• Platelet count ≤100 x 109/L unrelated to therapy
• Additional clonal cytogenetic abnormalities in Ph+ cellsc

Question 2

Define BP-CML (NCCN v3 2025)

Answer 2

IBMTR criteria3
• ≥30% blasts in the blood, marrow, or both
• Extramedullary infiltrates of leukemic cells

Question 3

Risk stratification (NCCN v3 2025)

Answer 3

• Sokal
• Euro
• EUTOS long term survival (ELTS) score

Question 4

Sokal score (NCCN v3 2025)

Answer 4

Spleen size, plt, blast

Question 5

Hasford (Euro score) (NCCN v3 2025)

Answer 5

Age, spleen size (below cm costal margin), %blast, %eo, %basophil , plt count

Question 6

EUTOS long term survival (ELTS) score (NCCN v3 2025)

Answer 6

Age, spleen size in cm below costal margin, %blasts in PB, plt count

Question 7

Complete hematologic response (CHR)

Answer 7

• complete normalization of pb counts c wbc <10k
• plt count <450k
• no immature cells eg myelocytes, promyelocytic , blasts in pb
• No S&S of ds w/ resolution of palpable splenomegaly

Question 8

Cytogenetic response

Answer 8

• Complete cytogenetic response (CCyR): No Ph-positive metaphases
• Major cytogenetic response (MCyR): 0%–35% Ph-positive metaphases
• Partial cytogenetic response (PCyR): 1%–35% Ph-positive metaphases
• Minor cytogenetic response: >35%–65% Ph-positive metaphases

Question 9

Molecular response

Answer 9

• Early molecular response (EMR): BCR::ABL1 (IS) ≤10% at 3 and 6 months
• Major molecular response (MMR): BCR::ABL1 (IS) ≤0.1% or
≥3-log reduction in BCR::ABL1 transcripts from the standardized baseline, if qPCR (IS) is not available
• Deep molecular response (DMR): MR4.0: BCR::ABL1 (IS) ≤0.01% or MR4.5: BCR::ABL1 (IS) ≤0.0032%

Question 10

CML response (3)

Answer 10

1. Complete hematologic response (CHR)
2. Cytogenetic response
3. Molecular response

Question 11

Define relapse

Answer 11

• Any sign of loss of hematologic response
• Any sign of loss of CCyR or its molecular response correlate (MR2.0: BCR::ABL1 [IS] ≤1%)
in BCR::ABL1 transcript to >1%
• 1-log increase in BCR::ABL1 transcript levels with loss of MMR8