NCCN Guidelines for Patients® | Chronic Myeloid Leukemia

34 NCCN Guidelines for Patients ® : Chronic Myeloid Leukemia, 2018 CML is most often diagnosed in the chronic phase. However, it can progress to the accelerated phase or blast phase. Treatment is less standardized for these advanced phases because they are less common. Doctors agree that the best chance of a cure is with an HCT. In Part 5, diagnosis and treatment of advanced phases are explained. Additional testing In Part 2, tests needed to plan CML treatment were described. For advanced phases, a few more tests are required. Some of these tests will reveal more about the CML you have. Other tests are needed for certain treatments. Flow cytometry Flow cytometry is a method used to assess surface proteins on cells. It is performed on either blood or bone marrow. First, a marker—a light-sensitive dye— will be added to the sample. Then, your blood will be passed through a flow cytometry machine. The machine measures surface proteins on thousands of cells. Flow cytometry is used to find out the type of cells present. It’ll show if the leukemia cells are mostly myeloid cells or lymphoid cells. This test is important because the cell type may affect which treatment is best for you. Mutation testing New mutations in the BCR-ABL1 gene may occur over time. They can happen as CML progresses to advanced phases. They can also happen during treatment for CML. Mutation testing is used to assess for these new mutations. Testing can be performed on blood or bone marrow. It should be done prior to starting treatment for advanced phase CML. HLA testing Not everyone can receive an allogeneic HCT. It can be hard on the body. Your doctor will assess if it is an option for you. If it is, testing will be needed. HLAs ( h uman l eukocyte a ntigens) are proteins found on the surface of most cells. They are markers of your body’s cells. They allow your body to tell which cells are its own and which are foreign. HLAs do not differ between cells within a person. In other words, all your cells have the same set of HLAs. Each person’s set of HLAs is called the HLA type or tissue type. HLA typing is a test that detects a person’s HLA type. You will receive this test if HCT may be a treatment option. HLA typing is needed to find the right donor for you. A donor’s HLA type must be a near-perfect match to you for treatment to work. Otherwise, your body will reject the donor’s stem cells. Lumbar puncture CML in the blast phase can spread into the fluid around the brain and spinal cord. This fluid is called cerebrospinal fluid or spinal fluid. To confirm that CML is in spinal fluid, a sample must be removed and tested. A lumbar puncture is a procedure that removes spinal fluid. It is also called a spinal tap. It is advised for blast phase CML if mostly lymphoid cells are present. During a spinal tap, you will be lying down or sitting on an exam table. If lying down, your knees must 5 Advanced phases Additional testing