Chronic Myeloid Leukemia Following Treatment for Primary Neoplasms or Other Medical Conditions

A Report of 21 Cases and Review of the Literature

Lian-He Yang, MD, PhD; Pu Su, MD, PhD; Catherine Luedke, MD; Chuanyi Mark Lu, MD; Abner Louissaint Jr, MD, PhD; Chad M. McCall, MD, PhD; Sarah Rapisardo, PhD; Bethany Vallangeon, MD; Endi Wang, MD, PhD

Disclosures

Am J Clin Pathol. 2018;150(3):246-258.

Materials and Methods

Case Selection

Following approval of the study by the institutional review board of Duke University Medical Center, we retrieved cases of therapy-related CML from our pathology database for the past 13 years. Twelve cases were from Duke University Medical Center and the remaining nine cases were from collaborating academic institutions, including Massachusetts General Hospital (n = 6) and the University of California San Francisco Medical Center (n = 3). All the cases were retrospectively evaluated by three hematopathologists (C.M.L., A.L., and E.W.), and the diagnosis of each individual case was confirmed according to the World Health Organization classification of tumors of hematopoietic and lymphoid tissues.^[1,2] Clinical histories and laboratory data, including flow cytometric analyses, cytogenetic studies, and molecular diagnostic tests, were collected and retrospectively reviewed and analyzed.

Literature Review

A PubMed literature search was performed using relevant title words, such as "chronic myelogenous leukemia" or "chronic myeloid leukemia," "therapy-related," "following" or "after," and "secondary." Previously published cases of therapy-related CML were reviewed, collected, and analyzed.

Statistical Analysis

Statistical analyses were performed with IBM SPSS Statistics, version 22 (www.ibm.com). Overall survival was calculated using Kaplan-Meier survival analysis, generating the estimated median survival and a 95% confidence interval.

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Table 1. The Characteristics of Secondary Chronic Myeloid Leukemia in 21 Cases
Case	Age, y	Sex	Primary Disease	Therapy for Primary Disease	Interval to CML, mo	CML Phase	Conventional Cytogenetics	FISH for BCR/ABL	Molecular Genetics	Therapy for CML	Follow-up, mo	Outcome
1	72	M	Follicular lymphoma	CT	81	Chronic	t(9;22)	NA	b2a2;e1a2	IB, HY	64+	CMR
2	88	F	Adenocarcinoma	RT	10	Chronic	t(1;16),t(9;22)	NA	b2a2	IB, HY	5	Dead
3	68	M	AITL	CT	80	Chronic	NA	BCR/ABL	NA	IB	27	Dead
4	45	M	Pheochromocytoma	CT+RT	48	Chronic	NA	BCR/ABL	b2a2	IB, HY, AL	113+	PMR
5	52	F	Breast carcinoma (ductal)	RT	89	Chronic	t(9;22)	BCR/ABL	b2a2	NB	49+	CMR
6	64	F	Breast carcinoma (ductal)	CT+RT	168	Chronic	t(9;22)	BCR/ABL	b3a2	IB	48+	CMR
7	53	M	Heart failure	Heart transplant	16	Chronic	t(9;22)	BCR/ABL	NA	NA	13+	PR
8	38	F	Renal failure	Kidney transplant	36	Chronic	t(9;22)	BCR/ABL	b3a2	IB	51+	PR
9	47	M	B-ALL	CT	144	NA	t(9;22)	BCR/ABL	NA	IB, DB	6+	B-ALL
10	44	F	Breast carcinoma	CT+RT	32	NA	t(9;22)	BCR/ABL	b3a2	IB	33+	CCR, PMR
11	68	M	Bladder cancer	Excision	84	NA	t(9;22)	BCR/ABL	b3a2;b2a2	IB, DB	22+	PMR
12	70	F	B-ALL	CT	24	Chronic	t(9;22)	NA	b3a2;b2a2	NB, DB, SCT	9+	CCR, PMR
13	64	M	Follicular lymphoma	CT	104	Chronic	t(1;17),t(9;22)	NA	b3a2	IB	86+	CMR
14	79	M	Prostate cancer	CT+RT	71	Chronic	t(9;22)	NA	b2a2	IB	5+	PMR
15	52	M	Ampulla of Vater cancer	RT	77	Chronic	t(9;22)	NA	b3a2;b2a2	IB	22+	CHR
16	56	F	Thyroid	CT+RT	141	Chronic	t(9;22)	NA	b3a2;b2a2	IB, HY, DB	19+	PMR
17	61	F	Lung cancer	RT	36	Chronic	t(9;22)	NA	b2a2	NA	NA	NA
18	57	M	Rectal cancer	CT+RT	66	Chronic	t(9;22)	BCR/ABL	b2a2	IB, AL	1+	PR
19	75	M	DLBCL	CT+RT	60	NA	NA	BCR/ABL	b2a2	IB, RB	26+	CMR
20	70	M	Cholangiocarcinoma	CT+RT	15	Chronic	t(9;22)	BCR/ABL	b3a2	IB	12+	CCR, PMR
21	79	F	Plasmacytoma	CT+RT	180	Chronic	t(9;22)	BCR/ABL	b3a2	IB	NA	NA

AITL, angioimmunoblastic T-cell lymphoma; AL, allopurinol; B-ALL, B-lymphoblastic leukemia; CCR, complete cytogenetic response; CHR, complete hematologic response; CML, chronic myeloid leukemia; CMR, complete molecular response; CT, chemotherapy; DB, dasatinib; DLBCL, diffuse large B-cell lymphoma; HY, hydroxyurea; IB, imatinib; NA, not available; NB, nilotinib; PMR, partial molecular response; PR, partial hematologic response; RB, ruxolitinib; RT, radiotherapy; SCT, stem cell transplant.

Table 2. The Characteristics of Therapy-Related Chronic Myeloid Leukemia in Literature
Case No.	1st Author	Reference	Age, y	Sex	Primary Disease	Therapy for Primary Disease	Interval to CML, mo	CML Phase	Conventional Cytogenetics	FISH for BCR/ABL	Molecular Genetics	Therapy for CML	Follow-up, mo	Outcome
1	Wang X	4	NA	NA	Polycythemia vera	CT	144	NA	NA	BCR/ABL	JAK2 V617F (+)	NA	NA	NA
2	Wang X	4	NA	NA	Polycythemia vera	NA	216	NA	NA	BCR/ABL	JAK2 V617F (+)	NA	NA	NA
3	Buxhofer-Ausch V	5	61	M	Colorectal cancer	CT	60	Blast	t(9;22)	BCR/ABL	NA	IB	1+	NA
4	Higuchi M	6	58	F	Advanced gastric cancer	CT	39	Chronic	t(9;22)	BCR/ABL	NA	IB	3+	CCR
5^a	Nakamura H	7	60	M	Esophageal cancer	CT	48	Chronic	t(9;22)+complex	BCR/ABL	NA	HY, cytarabine, doxorubicin	9	Dead
6	Ragupathi L	8	63	F	Multiple myeloma	CT+RT	17	NA	t(9;22)	BCR/ABL	NA	DB	7+	CCR
7^a	Pedersen-Bjergaard J	9	46	M	Germ cell tumor	CT	66	NA	t(9;22)+8	BCR/ABL	NA	RT, SCT	8+	CHR
8^a	Ritch PS	10	41	M	Hodgkin lymphoma	Partial gastrectomy	46	Chronic	t(9;22)	NA	NA	Busulfan	216+	CHR
9^a	Teichmann JV	11	59	F	CLL	CT	70	Chronic	t(9;22)	NA	NA	Busulfan	15+	CHR
10	Manabe M	12	59	M	Rectal adenocarcinoma	CT	39	Chronic	t(9;22)	BCR/ABL	NA	IB, DB, NB	24+	CCR, MMR
11	Yoon HS	13	14	M	Langerhans cell histiocytosis	CT	8	Chronic	t(9;23)	BCR/ABL	b2a2	IB	3+	HR
12	Walgraeve D	14	47	M	Thyroid cancer	RT	60	NA	t(9;22)	BCR/ABL	NA	NA	NA	NA
13	Abu-Ghanem S	15	50	F	Breast cancer	CT+RT	13	Chronic	NA	BCR/ABL	NA	IB, HY	29+	CCR, MMR
14	Abu-Ghanem S	15	35	F	Breast cancer	CT+RT	30	Chronic	NA	BCR/ABL	NA	IB, HY, interferon-α	12+	CMR
15^a	Iurlo A	16	51	M	Seminoma cancer	RT	48	Chronic	t(9;22)	NA	NA	Busulfan	24+	CHR
16	Cazzola M	17	66	F	Non-Hodgkin lymphoma	CT+RT	84	Chronic	t(9;22)	NA	NA	NA	17+	NA
17	Chap L	18	48	F	Histiocytosis syndrome	CT+RT	156	Chronic	t(9;22)	NA	NA	NA	24+	NA
18	Noda M	19	48	M	Lymphoplasmacytic lymphoma	CT	10	Chronic	NA	BCR/ABL	NA	IB	74+	CMR
19	Ishiyama T	20	52	M	Gastric cancer	CT	33	NA	t(9;22)	NA	NA	NA	NA	NA
20^a	Shimon I	22	35	M	Thyroid cancer	RT	66	NA	NA	BCR/ABL	NA	HY	60+	NA
21^a	Shimon I	22	61	NA	Thyroid cancer	RT	123	NA	t(9;22)	NA	NA	Interferon-α	NA	NA
22^a	Wandroo FA	23	49	M	Hairy cell leukemia	CT	48	NA	t(9;22)	NA	NA	Interferon	Couple of weeks	Dead
23	Langabeer SE	24	62	M	Prostate cancer	RT	36	Chronic	t(9;22)	BCR/ABL	e14a2	NB	8+	CCR, MMR
24	Ramanarayanan J	25	33	F	Hodgkin lymphoma	CT+RT	122	NA	t(9;22)	BCR/ABL	NA	IB, SCT	21+	CMR
25	Ramanarayanan J	25	49	M	Non-Hodgkin lymphoma	CT+RT	108	NA	t(9;22)	BCR/ABL	NA	IB	34+	CCR
26	Ramanarayanan J	25	57	F	CLL	CT+RT+ SCT	66	Chronic	t(9;22)	BCR/ABL	NA	IB	36+	CCR
27^a	Wang KL	26	27	M	Papillary thyroid carcinoma	RT	156	NA	t(9;22)	NA	NA	HY, SCT	NA	NA
28	Xu XH	27	32	M	AML	CT	62	Chronic	t(9;22)	BCR/ABL	JAK2 V617F (–)	IB	20+	CHR, PCR, CMR
29	Alsop S	28	20	M	ALK+ALCL	CT	49	NA	t(9;22)	BCR/ABL	p210	IB, HY, AL, SCT	23+	CHR
30	Lee HY	29	50	M	DLBCL	CT+RT	118	NA	t(9;22)	BCR/ABL	NA	IB	32+	CCR
31	Zahra K	30	6	F	DLBCL	CT	14	Accelerated	t(9;22),t(4;9)	BCR/ABL	e1a2	IB, HY, AL	6	Dead
32	Demiriz IŞ	31	49	F	DLBCL	CT	53	Chronic	t(9;22)	NA	JAK2(–)	IB	24+	CHR, CCR, MMR
33^a	Huang F	32	50	M	Acute promyelocytic leukemia	CT, arsenic trioxide	84	Chronic	t(9;22)	BCR/ABL	b3a2	HY, interferon-α	2	Dead
34	Tsuzuki M	33	69	M	Gastric cancer	CT+RT	77	Chronic	t(9;22)	BCR/ABL	NA	IB	9+	MCR, MMR
35	Vakili-Sadeghi M	34	57	M	Rectosigmoid adenocarcinoma	CT	23	Chronic	NA	BCR/ABL	NA	IB	6	Dead
36	Porta C	35	74	F	Breast cancer	CT	84	NA	t(9;22)	NA	NA	NA	NA	NA
37	Kadikoylu G	36	66	M	Rectal carcinoma	CT	32	Chronic	t(9;22)	BCR/ABL	p210	IB	1+	CHR
38^a	Gokel Y	38	62	M	Colon cancer	CT	12	NA	t(9;22)	NA	NA	HY	1	Dead
39	Sakamoto E	39	58	F	Gastrointestinal stromal tumors	NA	12	Chronic	t(9;22)	BCR/ABL	NA	IB	NA	CCR, CMR
40^a	Bolaños-Meade J	40	82	M	CLL	CT	84	Chronic	t(9;22),mar	BCR/ABL	b2a2; p210	Fludarabine	8+	PR
41	Hosseini S	41	17	F	B-ALL	CT+RT	56	Chronic	t(9;22)	BCR/ABL	p210	IB	20+	CHR, CMR
42	Philip P	42	71	F	Uterus cancer	RT	81	Chronic	t(9;22),t(6;8)	NA	NA	NA	NA	NA
43	Philip P	42	53	F	Uterus cancer	RT	27	Chronic	t(9;22)	NA	NA	NA	NA	NA
44	Philip P	42	40	M	Testicular cancer	RT	36	Chronic	t(9;22)	NA	NA	NA	NA	NA
45^a	Yamamura R	43	33	M	Malignant fibrous histiocytoma	CT+ SCT	58	Chronic	t(9;22)	BCR/ABL	NA	HY, interferon-α, SCT	4	Dead
46	Czarnecka AM	44	59	M	Clear cell renal cell cancer	CT+RT	65	NA	t(9;22)	BCR/ABL	NA	IB, sunitinib	18	Dead
47	Czarnecka AM	44	58	M	Clear cell renal cell cancer	CT	173	NA	NA	BCR/ABL	NA	HY, sorafenib	25	Dead
48	Czarnecka AM	44	81	M	Clear cell renal cell cancer	CT	64	NA	t(9;22)	BCR/ABL	NA	IB, DB, HY, sunitinib	28	Dead
49^a	Wahlin A	45	58	M	Essential thrombocythemia	CT	216	Chronic	t(9;22)	BCR/ABL	NA	HY, interferon-α, SCT	12+	CCR, CMR
50^a	Bouabdallah K	46	54	M	Hodgkin lymphoma	CT+RT	192	Chronic	t(9;22),+8	BCR/ABL	NA	Interferon-α, SCT	22	Dead
51	Advani SH	47	NA	F	Thyroid cancer	RT	84	NA	t(9;22)	NA	NA	NA	NA	NA
52	Verhoef GE	51	65	M	Hodgkin lymphoma	CT	96	Chronic	t(9;22)	BCR/ABL	NA	NA	10+	NA
53	Salvagno L	52	41	M	Hodgkin lymphoma	CT+RT	43	Chronic	t(9;22)	NA	NA	NA	205	Dead
54^a	Jackson GH	53	21	F	Hodgkin lymphoma	CT+RT	22	Chronic	t(9;22)	NA	NA	HY	12+	NA
55	Tester WJ	54	24	M	Hodgkin lymphoma	CT+RT	44	Chronic	t(9;22)	NA	NA	NA	57	Dead
56	Hsiao HH	55	32	F	Intestinal lymphoma	CT+ SCT	20	Chronic	t(9;22)	BCR/ABL	NA	HY, interferon-α	21	Dead
57^a	Waller CF	56	42	M	Small cell lung cancer	CT+RT+SCT	28	Chronic	t(9;22)	BCR/ABL	NA	HY	24+	CHR, PCR
58	Louis R	57	71	M	DLBCL	CT	72	NA	NA	BCR/ABL	NA	IB	1+	PHR
59^a	Numata A	58	21	F	Ewing sarcoma	CT+RT+ SCT	50	Chronic	t(9;22)	BCR/ABL	NA	HY, interferon-α	6+	CHR
60	Shibazaki M	59	64	F	Breast cancer, follicular lymphoma	CT+RT	36	Chronic	t(9;22) −7	BCR/ABL	NA	IB, DB, SCT	24+	CMR
61	Bahamadi SA	60	80	M	Pleomorphic liposarcoma	CT+RT	168	Chronic	t(9;22), −7, −5q	BCR/ABL	NA	IB	0.5+	CHR
62	Aguiar RC	61	NA	NA	Thymoma, myasthenia gravis	CT+RT+steroids	48	NA	NA	NA	p53(–)p16(–) p15(–)	NA	NA	NA
63	Aguiar RC	61	NA	NA	Chronic lymphocytic leukemia	CT	27	NA	NA	NA	p53(–)p16(–) p15(–)	NA	NA	NA
64	Aguiar RC	61	NA	NA	Testicular seminoma	CT+RT	60	NA	NA	NA	p53(–)p16(–) p15(–)	NA	NA	NA
65	Aguiar RC	61	46	M	Thymoma	CT+RT	48	Chronic	t(9;22)	BCR/ABL	NA	NA	12	Dead
66	Mirza I	62	82	F	Polycythemia vera	CT+RT	72	NA	t(9;22)	BCR/ABL	JAK2 V617F	IB; HY	4.5	Dead
67	Mirza I	62	73	F	Polycythemia vera	CT	180	Accelerated	t(9;22)	BCR/ABL	JAK2 V617F	IB	24+	PR
68	Iriyama N	64	72	F	Breast cancer	CT	48	Chronic	t(9;22)	NA	NA	IB	NA	NA
69	Iriyama N	64	75	M	Prostate cancer	RT	24	Chronic	t(9;22)	NA	NA	NB, DB	NA	NA
70	Iriyama N	64	62	M	Pharyngeal cancer	RT	60	Chronic	t(9;22)	NA	NA	NB	NA	NA
71	Iriyama N	64	66	M	Mesothelioma	CT	14.4	Chronic	t(9;22)	NA	NA	IB	NA	NA
72	Iriyama N	64	57	F	Lung cancer	CT	192	Chronic	t(9;22)	NA	NA	IB	NA	NA
73	Iriyama N	64	47	M	Colon cancer	CT	48	Chronic	t(9;22)	NA	NA	NB	NA	NA
74	Iriyama N	64	76	M	Ureter cancer	CT	96	Chronic	t(9;22)	NA	NA	DB	NA	NA
75	Iriyama N	64	38	F	ALL	CT	396	Chronic	t(9;22)	NA	NA	IB	NA	NA
76	Iriyama N	64	55	F	Gastric cancer	CT	96	Chronic	t(9;22)	NA	NA	IB	NA	NA
77	Iriyama N	64	49	F	Breast cancer	CT+RT	84	Chronic	t(9;22)	NA	NA	DB	NA	NA
78	Iriyama N	64	71	M	Bladder cancer	CT	144	Chronic	t(9;22)	NA	NA	IB, NB	NA	NA
79	Robak T	66	17	M	Pineal germinoma	CT+RT	63	Chronic	NA	NA	NA	NA	NA	CHR
80	Nakagawa Y	67	27	M	Still disease	CT	24	NA	t(9;22)	BCR/ABL	NA	IB	NA	PR
81^a	Pavithran K	68	31	M	Myasthenia gravis	Thymectomy+steroids	68	Chronic	t(9;22)	BCR/ABL	b3a2; p210	HY	6+	PR
82	Pavithran K	68	40	M	Papillary thyroid carcinoma	RT	166	NA	t(9;22)	BCR/ABL	b3a2; p210	IB, interferon-α	30+	CHR, PCR
83	Pelloso LA	69	37	M	End-stage kidney disease	Renal transplant	32	Chronic	t(9;22)	NA	NA	NA	NA	NA
84	Whang-Peng J	70	76	M	CLL	CT	24	Chronic	t(9;22),-Y	NA	NA	NA	24+	NA
85	Whang-Peng J	70	77	F	Non-Hodgkin lymphoma	CT	NA	Chronic	t(9;22)	NA	NA	NA	7	Dead
86	Whang-Peng J	70	37	F	ALL	CT	18	Chronic	t(9;22),complex	NA	NA	NA	34	Dead
87	Whang-Peng J	70	61	M	CLL	RT	36	Chronic	t(9;22)	NA	NA	NA	19	Dead
88	Whang-Peng J	70	61	F	Breast cancer	RT	108	Chronic	t(9;22)	NA	NA	NA	NA	NA
89	Whang-Peng J	70	28	M	Hodgkin lymphoma	CT+RT	46	Chronic	t(9;22)	NA	NA	NA	12	Dead
90	Whang-Peng J	70	52	F	Breast cancer	CT+RT	96	Chronic	t(9;22),complex	NA	NA	NA	31	Dead
91	Waldman D	71	12.5	M	Nasopharyngeal carcinoma	CT+RT	48	NA	t(9;22)	BCR/ABL	NA	IB	4+	CHR, CCR, CMR
92	Waldman D	71	25	F	DLBCL	CT	108	NA	NA	BCR/ABL	NA	IB	12+	CCR
93^a	Schreiber ZA	75	63	M	CLL	CT	92	Chronic	t(9;22),complex	NA	NA	Busulfan, HY	18+	CHR
94^a	Bauduer F	76	69	F	Breast cancer	RT	120	Chronic	t(9;22)	BCR/ABL	p210	CT	33	Dead
95^a	Bauduer F	76	54	F	Breast cancer	CT+RT	20	Chronic	t(9;22)	BCR/ABL	p210	6-mer-captopurine, interferon-α	45	Dead
96^a	Bauduer F	76	66	F	Uterus cancer	RT	300	Chronic	t(9;22;10)	BCR/ABL	p210	HY, SCT	39+	CHR
97	Reddy KS	77	45	F	DLBCL	CT	132	Chronic	NA	BCR/ABL	NA	IB, SCT	36+	NA
98^a	Punt CJ	79	28	M	Hodgkin lymphoma	CT+RT	60	Chronic	t(9;22)	NA	NA	Busulfan, SCT	132+	CCR
99	Menon NM	81	4	F	AML	CT+SCT	31	Chronic	t(9;22)	BCR/ABL	p210	DB, rapamycin	12+	HR, MMR
100	Mele L	82	65	M	Non-Hodgkin lymphoma	CT+RT	84	Blast	t(9;22)	BCR/ABL	b2a2; p210	CT	9	Dead
101	Kneller A	84	35	F	Hodgkin lymphoma MDS	CT+RT+SCT	104	NA	t(9;22),complex	BCR/ABL	NA	NA	2	Dead
102	Dastugue N	87	64	F	Non-Hodgkin lymphoma	RT	84	Chronic	t(9;22),complex	NA	NA	NA	18	Dead
103	Breccia M	88	73	F	Breast cancer, non-Hodgkin lymphoma	CT+RT	228	Chronic	t(9;22)	NA	NA	IB	24+	CCR
104^a	Berman E	89	38	M	Hodgkin lymphoma	CT+RT	38	Chronic	t(9;22)	BCR/ABL	NA	Busulfan, cyclophosphamide, SCT	14+	CHR
105	Bansal S	90	58	M	Non-Hodgkin lymphoma	CT+RT	192	Chronic	t(9;22)	NA	NA	IB	84+	NA
106	Bansal S	90	NA	M	Psoriasis	CT	156	Accelerated	NA	NA	NA	IB	1	Dead
107^a	Auerbach HE	92	66	M	ALL	CT+RT	57	NA	t(9;22), −7	BCR/ABL	NA	HY, CT	3	Dead
108	Alshehry NF	93	31	F	Hodgkin lymphoma	CT+RT	48	Chronic	NA	BCR/ABL	NA	IB	36	Dead
109^a	Leone G	95	63	F	ALL	CT+RT	42	Chronic	t(9;22)	NA	NA	Busulfan	23+	CHR

ALK+ALCL, anaplastic lymphoma kinase positive anaplastic large cell lymphoma; ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; CCR, complete cytogenetic response; CHR, complete hematologic response; CLL, chronic lymphocytic leukemia; CML, chronic myeloid leukemia; CMR, complete molecular response; CT, combination chemotherapy; DB, dasatinib; DLBCL, diffuse large B-cell lymphoma; FISH, fluorescence in situ hybridization; IB, imatinib; HY, hydroxyurea; MDS, myelodysplastic syndrome; NA, not available; NB, nilotinib; PMR, partial molecular response; PR, partial hematologic response; RT, radiotherapy; SCT, stem cell transplant.
^aPatients who were not treated with IB or its derivatives.

Table 3. Summary of Clinicopathologic Features in the Reported Cases and Current Series
	Reported Cases	Present Cases	Combined Cases
No. of cases	109	21	130
Sex ratio (M:F)	1.4 (60:4)	1.6 (13:8)	1.43 (73:5)
Age at diagnosis of CML
Mean ± SD	50.62 ± 18.3	62 ± 13.2	52.6 ± 18
Median (range)	53.5 (4-82)	64 (38-88)	56 (4-88)
Type of therapy, No. of cases (% of total)
CT	48 (44.9%)	7 (33.3%)	55 (43.0%)
RT	18 (16.8%)	4 (19.1%)	22 (17.2%)
CT+RT	39 (36.4%)	9 (42.9%)	48 (37.5%)
Excision	2 (1.9%)	1 (4.8%)	3 (2.3%)
Interval to diagnosis of CML, mo
Mean ± SD	78.79 ± 64.0	74.38 ± 49.9	78.1 ± 61.7
Median (range)	60 (8-396)	71 (10-180)	60 (8-396)
CML phase, No. of cases (% of total)
Chronic phase	73 (93.6%)	18 (100.0%)	91 (94.8%)
Accelerated phase	3 (3.9%)	0 (0.0%)	3 (3.1%)
Blast crisis	2 (2.6%)	0 (0.0%)	2 (2.1%)
Cytogenetic profile, No. of cases (% of total)
t(9;22)	76 (83.5%)	17 (88.9%)	93 (84.6%)
t(9;22),+8	2 (2.2%)	0 (0%)	2 (1.8%)
t(9;22),+mar	1 (1.1%)	0 (0%)	1 (0.9%)
t(9;22), −7 or −5q	3 (3.3%)	0 (0%)	3 (2.7%)
t(9;22), −Y	1 (1.1%)	0 (0%)	1 (0.9%)
t(1;17),t(9;22)	0 (0%)	1 (5.6%)	1 (0.9%)
t(1;16),t(9;22)	0 (0%)	1 (5.6%)	1 (0.9%)
t(4;9),t(9;22)	1 (1.1%)	0 (0%)	1 (0.9%)
t(6;8),t(9;22)	1 (1.1%)	0 (0%)	1 (0.9%)
t(9;22;10)	1 (1.1%)	0 (0%)	1 (0.9%)
t(9;22),+complex	6 (6.6%)	0 (0%)	6 (5.5%)
Follow-up and outcome
Dead
No. of cases (% of total)	29 (39.7%)	2 (10.5%)	31 (33.7%)
Mean, mo ± SD	24.0 ± 38.4	16 ± 15.6	23.4 ± 37.2
Median, mo (range)	15 (1-205)	16 (5-27)	15 (1-205)
Alive
No. of cases (% of total)	44 (60.3%)	17 (89.5%)	61 (66.3%)
Mean, mo ± SD	26.5 ± 35.8	34.06 ± 31.0	26.5 ± 35.8
Median, mo (range)	20 (0.5–216)	22 (1-113)	20 (0.5–216)