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CML in accelerated or blast phase: ≥10% blasts in PB or BM (accelerated), ≥20% blasts (bl...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

IDRF-CML-TRANSFORMATION-PROGRESSION
TypeRed flag
Statusreviewed 2026-04-25 | pending_clinical_signoff
DiseasesDIS-CML
SourcesSRC-ELN-CML-2020 SRC-ESMO-CML-2017 SRC-NCCN-MPN-2025

Red Flag Origin

DefinitionCML in accelerated or blast phase: ≥10% blasts in PB or BM (accelerated), ≥20% blasts (blast phase), or extramedullary blasts. Treatment intent shifts from chronic-phase TKI to acute-leukemia-style induction + alloHCT.
Clinical directionhold
Categorytransformation-progression
Shifts algorithmALGO-CML-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "cml_phase",
      "value": "accelerated"
    },
    {
      "finding": "cml_phase",
      "value": "blast"
    },
    {
      "comparator": ">=",
      "finding": "blasts_pb_pct",
      "threshold": 10
    },
    {
      "comparator": ">=",
      "finding": "blasts_bm_pct",
      "threshold": 10
    },
    {
      "finding": "extramedullary_blasts",
      "value": true
    }
  ],
  "type": "composite"
}

Notes

Triggers HOLD on chronic-phase 1L algorithm. Accelerated/blast-phase CML is a clinical emergency: high-dose 2nd/3rd-gen TKI (dasatinib 140 mg or ponatinib if T315I), urgent donor search for alloHCT, induction chemotherapy (myeloid blast: AML-style 7+3; lymphoid blast: hyperCVAD + TKI). Plan generation does not proceed with chronic-phase regimen selection — describes the blast-phase workup. Priority bumped to 10. STUB — requires clinical co-lead signoff.

Used By

Algorithms

Indications