I will like to subscribe to Prof. Goldman's position that if the cells are predominantly blasts we take is as blastic phase of the disease. I have a number of patients in chronic phse but with concomitant subcutaneuous nodules; aspiration biopsies however revealed mature granulocytes only but very few blasts. They were managed as chronic phase CML and are currently doing vwey well.

Patients with granulocytic sarcoma even if they have normal bone marrow are treated on the lines of AML. With the same logic, CML patients with granulocytic sarcoma whose bone marrow is still in chronic phase should be considered to have myeloid blast crisis.

I would say it does depend on the diagnosis of granulocytic sarcoma. If the predominant cell is a blast cell, this must be regarded as blastic phase CML and treated accordingly, with TKI, cytotoxic drugs and perhaps radiotherapy. The term has also been used, perhaps erroneously for what is merely a collection of fully differentiated cells of the granulocytic series. Here one might make a case for calling it chronic phase, but I still would be dubious.

John Goldman

If a CML patient comes in with haematological picture of chronic phase but with granulocytic sarcoma.
Do you consider the disease to be in "Chronic phase" or "Acute phase"