Blast crisis

Last reviewed: 24 Aug 2022
Last updated: 24 Aug 2022

Summary

Definition

History and exam

Key diagnostic factors

  • splenomegaly
  • fatigue
  • malaise
  • night sweats
  • fever
  • abnormal/excessive bleeding
  • bone pain
More key diagnostic factors

Other diagnostic factors

  • weight loss
  • petechiae, ecchymoses, or easy bruising
  • infection
  • abdominal pain
  • visual changes
  • focal neurological signs
  • priapism
  • tinnitus
  • confusion or stupor
Other diagnostic factors

Risk factors

  • history of chronic myeloid leukaemia (CML)
  • exposure to alkylating chemotherapeutic agents
  • exposure to ionising radiation
More risk factors

Diagnostic investigations

1st investigations to order

  • FBC and differential
More 1st investigations to order

Investigations to consider

  • peripheral blood smear
  • bone marrow aspiration and biopsy
  • fluorescence in situ hybridisation
  • quantitative reverse-transcriptase polymerase chain reaction
  • flow cytometry
  • T315I gene mutation analysis
  • HLA1 testing
  • serum leukocyte alkaline phosphatase
  • serum vitamin B12
More investigations to consider

Treatment algorithm

ACUTE

lymphoid blast crisis

myeloid blast crisis

biphenotypic blast crisis

ONGOING

suboptimal response to initial treatment

partial haematological response or second chronic phase

transplant failure or recurrence post-transplant

Contributors

Authors

Carlos Palacio, MD, MPH, FACP
Carlos Palacio

Professor of Medicine

University of Florida College of Medicine

Jacksonville

FL

Disclosures

CP declares that he has no competing interests.

Marwan E. Shaikh, MD

Assistant Professor

College of Medicine

Division of Hematology and Oncology

Mayo Clinic Jacksonville

Jacksonville

FL

Disclosures

MES declares that he has no competing interests.

Acknowledgements

Dr Carlos Palacio and Dr Marwan E. Shaikh would like to gratefully acknowledge Fauzia Rana, a previous contributor to this topic.

Disclosures

FR declares that she has no competing interests.

Peer reviewers

Danilo Perrotti, MD, PhD

Assistant Professor of Human Cancer Genetics

Ohio State University

Columbus

OH

Disclosures

DP declares that he has no competing interests.

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