Krisis Blast

ETIOLOGI
• Blast crisis of CML defined by WHO by one of the following
features:
• ≥20 percent blasts in peripheral blood or bone marrow
• Extramedullary proliferation of blasts (ie, myeloid sarcoma)
PATOFISIOLOGI
TEMUAN KLINIS
Significant disruption in the production of normal blood cells, leading to
a variety of clinical manifestations :
• Anemia
• Infections
• Bleeding Tendencies
• Fever
• Splenomegaly
• Bone Pain
• Weight Loss
• Lymphadenopathy
TEMUAN LAB dan IMAGING
1.High White Blood Cell (WBC) Count with shifting
2.Low Hemoglobin (Hb) Level
3.Low Platelet Count
4.Peripheral Blood Smear
5.Bone Marrow Aspiration and Biopsy >20% of blast cells infiltrating
the marrow, crowding out the normal hematopoietic cells
6.Cytogenetic and Molecular Testing Detection of the BCR-ABL1
fusion gene
DX KRITERIA
1.Peripheral Blood Examination
2.Bone Marrow Examination
3.Immunophenotyping: Flow cytometry or immunophenotyping is
often used to further characterize the blast cells and confirm their
leukemic origin.
4.Cytogenetic and Molecular Studies: to identify the presence of the
BCR-ABL1 fusion gene associated with CML.
TERAPI dan PROGNOSIS
• Goal of therapy — The goal of initial management of CML
blast crisis is to revert to chronic phase
• Lymphoid blast crisis (30%) — A TKI can be administered alone or
in combination with lower intensity chemotherapy
• Myeloid blast crisis — The preferred initial treatment is the use of
a TKI (with or without chemotherapy) followed by an allogeneic
HCT for eligible patients.
• The prognosis of blast crisis in chronic myeloid leukemia (CML) is
generally poor compared to the earlier phases of the disease.