Henry Ford Hospital Medical Journal


Current analysis indicates a median survival of 3.6 months in 356 cases of chronic granulocytic leukemia after onset of blast transformation. Thirty-five (10.0%) complete remissions (CR), all of short duration, were observed. Closer scrutiny of the reported clinical experience offers clues for improving this poor outlook. A 76% CR rate can be extracted from this total experience by identifying cases treated with cytoslne arabinoside combined with one or more other agents. In isolated reports, weekly vincristine and prednisone have yielded good remission rates. Two general morphologic types of blasts can be distinguished by cytochemical stains and other features: lymphoid and nonlymphoid (myeloid, monocytoid). We suggest that the lymphoid type of blast crisis Is more responsive to vincristine-prednisone, whereas combination chemotherapy, containing cytoslne arabinoside, is more effective in nonlymphoid crises. We report a blast crisis in which two CRs occurred. The patient survived 19 months after onset, possibly because he also received BCC.