We dive into the recognition and management of blast crisis.
Hosts:
Sadakat Chowdhury, MD
Brian Gilberti, MD
Show Notes
Topic Overview
- Blast crisis is an oncologic emergency, most commonly seen in chronic myeloid leukemia (CML).
- Defined by:
- >20% blasts in peripheral blood or bone marrow.
- May include extramedullary blast proliferation.
- Without treatment, median survival is only 3–6 months.
Pathophysiology & Associated Conditions
- Usually occurs in CML, but also in:
- Myeloproliferative neoplasms (MPNs)
- Myelodysplastic syndromes (MDS)
- Transition from chronic to blast phase often reflects disease progression or treatment resistance.
Risk Factors
- 10% of CML patients progress to blast crisis.
- Risk increased in:
- Patients refractory to tyrosine kinase inhibitors (e.g., imatinib).
- Those with Philadelphia chromosome abnormalities.
- WBC >100,000, which increases risk for leukostasis.
Clinical Presentation
- Symptoms often stem from pancytopenia and leukostasis:
- Anemia: fatigue, malaise.
- Functional neutropenia: high WBC count, but increased infection/sepsis risk.
- Thrombocytopenia: bleeding, bruising.
- Leukostasis/hyperviscosity effects by system:
- Neurologic: confusion, visual changes, stroke-like symptoms.
- Cardiopulmonary: ARDS, myocardial injury.
- Others: priapism, limb ischemia, bowel infarction.
