This patient gives a history of palpitations for the past two days. On questioning she has noted occasional night sweats, and describes some abdominal fullness, but otherwise is usually fit and well with no significant past medical history. She is not on any medication currently. She has one brother and is married with 1 child.
On examination she has palpable splenomegaly, 5 cm below the costal margin. No lymphadenopathy.
Further blood tests show a mildly elevated ALP, normal renal function and LDH has also been checked which again is slightly elevated. Blood film is shown below.
BCR-ABL PCR was checked on peripheral blood and confirms the diagnosis of CML.
Bone marrow aspirate and trephine was undertaken. Aspirate showed 15% blasts, and trephine showed no evidence of clustering or megakaryocytes, and reticulin was found to be grade 1.
How do you stage this lady?
What treatment could be offered?
How would you monitor response?