Which one of the following is not a criterion for making a diagnosis of chronic myeloid leukemia in accelerated phase:
(A) Blasts 10-19% of WBC's in peripheral blood (B) Basophils 10-19% of WBC'S in peripheral blood (C) Increasing spleen size unresponsive to therapy (D) Persistent thrombocytosis (>1000 x 109/L) unresponsive to therapy
(D) Answer is D (Persistent thrombocytosis > 1000 x 109/L positive to therapy)Accelerated phase is associated with thrombocytopenia (9/L) and not thrombocytosis.Although multivariate analysis derived criteria also place blood or marrow basophils > 20% in disease criteria, other criteria do consider marrow and peripheral basophils > 10% as a criteria and hence option (D) is the single best answer here.Accelerated phase of CML: It is defined by the development of increasing degrees of anemia unaccounted for by bleeding or chemotherapy and is defined by several criteria. Multivariate analysis derived criteria Other commonly used criteriaCytogenetic clonal evolution Blood or marrow blasts between 10 and 20% Increasing drug dosage requirementBlood or marrow basophils > 20% Marrow reticulum or collagen fibrosis Platelet count < 100 x 10deg/L unrelated to therapy Marrow or peripheral blasts > 10%Marrow or peripheral basophils eosinophils - 10% Triad of WBC > 50 x 109/L, haematocrit < 25% and Mai,100 liP/L not controlled ii1111 therapy Unexplained fever or bone pain