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Understanding Chronic Phase CML (Chronic Myeloid Leukemia)

Doctors divide chronic myeloid leukemia into three phases: the chronic phase, accelerated phase, and blast phase. The chronic phase is the first phase and the easiest to treat.

Chronic myeloid leukemia (CML) is a type of leukemia that tends to grow slowly and usually has a positive outlook with standard treatment. It makes up about 30% of leukemias in adults.

Unlike many other cancers, doctors don't divide CML into stages. Instead, they divide CML into three phases based on how many abnormal cells they see in your blood and bone marrow samples.

These phases are:

About 90–95% of people diagnosed with CML are diagnosed in the chronic phase. CML in the chronic phase usually causes mild or no symptoms.

Read on to learn more about the chronic phase of CML, including how long it lasts, whether it's curable, and how it's treated.

CML phases are primarily determined by looking at how many blasts are in samples of your blood and bone marrow. Blasts are immature and abnormal cells that crowd out your healthy blood cells.

You'll be diagnosed with chronic phase CML if less than 10% of the cells in your blood and bone marrow samples are blasts.

People in the chronic phase of CML usually have no or mild symptoms and often respond to standard treatment.

Doctors sometimes shorten chronic phase CML to CP-CML.

The chronic phase of CML usually lasts 3–5 years without treatment. Progression to later phases is associated with a much poorer outlook and a higher chance of death. Many people who receive treatment for CML never advance past the chronic phase.

Since the development of a type of targeted therapy called tyrosine kinase inhibitors, the number of people who advance from the chronic phase to the accelerated phase or blast phase has dropped from 20% to about 1–1.5% per year.

In a 2020 study, researchers found that 9.2% of a group of 206 people with chronic phase CML treated with tyrosine kinase inhibitors advanced to the accelerated or blast phase over a 10-year period. The overall survival rate during this period was 87%.

The next phase of CML is called the accelerated phase, sometimes shortened to AP-CML. It's characterized by more than 10% but less than 20% blasts in your blood and bone marrow samples. During this phase, your number of cancerous cells increases faster, and you may develop symptoms such as:

The final phase is called the blast phase, blast crisis, or BP-CML. During this phase, more than 20% of the cells in your bone marrow and blood samples are blasts. Symptoms in this phase tend to be more severe than during the accelerated phase, and the outlook is generally poor.

About half of people in the blast phase live less than a year.

Learn more about CML treatment by phase.

Most people with CML are diagnosed in the chronic phase. The chronic phase is the easiest phase to treat.

Most people who are diagnosed in the chronic phase never advance to other phases of CML if they receive standard treatment.

Chronic phase CML can potentially be cured with a bone marrow transplant. Even if you're not eligible for a bone marrow treatment, CML can often be well-managed with a type of medication called tyrosine kinase inhibitors.

Chronic Myeloid Leukemia In Adults

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What Is Leukemia? Symptoms, Causes And Treatment

There are four main types of leukemia: acute lymphocytic leukemia (ALL), acute myelogenous leukemia (AML), chronic myelogenous leukemia (CML) and chronic lymphocytic leukemia (CLL), says Dr. Kolb.

Acute Lymphocytic Leukemia (ALL)

Characterized by the rapid proliferation and accumulation of immature lymphoid cells (which ordinarily give rise to normal lymphocytes), ALL is most common in children but can also occur in adults, says Dr. Scola.

ALL affects a person's blood cells and their immune system, says Dr. Kolb. An aggressive form of leukemia, ALL progresses rapidly if not treated right away, he says.

Acute Myelogenous Leukemia (AML)

Characterized by rapid proliferation and accumulation of immature myeloid cells (which ordinarily give rise to normal granulocytes, monocytes, red cells and platelets), AML is most common in adults but can occur at any age, says Dr. Scola.

In addition to being the most diagnosed leukemia, AML is also among the deadliest, says Dr. Kolb. There are more than 10 major subtypes of AML and countless rare mutations making cures difficult to achieve, he says, and it's aggressive.

Chronic Myelogenous Leukemia (CML)

Characterized by the slow proliferation and accumulation of mature and immature myeloid cells, CML can occur at any age but is most common in older adults, says Dr. Scola.

There are three phases of CML; chronic, accelerated or blast phase, says Dr. Kolb, but most patients are diagnosed in the chronic phase of CML with high white blood cell counts. They may or may not be exhibiting symptoms, he says, adding that the chronic phase of CML responds best to treatment.

Chronic Lymphocytic Leukemia (CLL)

Characterized by slow proliferation and accumulation of mature-appearing lymphoid cells, CLL occurs more frequently in older men and represents the most common form of leukemia in adults, says Dr. Scola.

It can grow slowly or progress rapidly, says Dr. Kolb, and there are several effective therapies for CLL. In some instances, a hematologist/oncologist may determine that a watch and wait approach is the best form of treatment, he says.

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