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May 1
10m 15s

Episode 209: Blast Crisis

CORE EM
About this episode

We dive into the recognition and management of blast crisis.

Hosts:
Sadakat Chowdhury, MD
Brian Gilberti, MD

Download 2 Comments Tags: Hematology, Oncology

Show Notes

Topic Overview

  • Blast crisis is an oncologic emergency, most commonly seen in chronic myeloid leukemia (CML).
  • Defined by:
    • >20% blasts in peripheral blood or bone marrow.
    • May include extramedullary blast proliferation.
  • Without treatment, median survival is only 3–6 months.

Pathophysiology & Associated Conditions

  • Usually occurs in CML, but also in:
    • Myeloproliferative neoplasms (MPNs)
    • Myelodysplastic syndromes (MDS)
  • Transition from chronic to blast phase often reflects disease progression or treatment resistance.

Risk Factors

  • 10% of CML patients progress to blast crisis.
  • Risk increased in:
    • Patients refractory to tyrosine kinase inhibitors (e.g., imatinib).
    • Those with Philadelphia chromosome abnormalities.
    • WBC >100,000, which increases risk for leukostasis.

Clinical Presentation

  • Symptoms often stem from pancytopenia and leukostasis:
    • Anemia: fatigue, malaise.
    • Functional neutropenia: high WBC count, but increased infection/sepsis risk.
    • Thrombocytopenia: bleeding, bruising.
  • Leukostasis/hyperviscosity effects by system:
    • Neurologic: confusion, visual changes, stroke-like symptoms.
    • Cardiopulmonary: ARDS, myocardial injury.
    • Others: priapism, limb ischemia, bowel infarction.
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