L1 VLP vaccine formulated with the MPL/alumin- ium salt combination (AS04) compared to alu- minium salt only. Vaccine, 24, 5937–5949. Kutler, D.I., Auerbach, A.D., Satagopan, J., Giampietro, P.F., Batish, S.D., Huvos, A.G., Go- berdhan, A., Shah, J.P. & Singh, B. (2003) High incidence of head and neck squamous cell carci- noma in patients with fanconi anemia. Archives of Otolaryngology – Head & Neck Surgery, 129, 106–112. Park, J.W., Pitot, H.C., Strati, K., Spardy, N., Duensing, S., Grompe, M. & Lambert, P.F. (2010) Deficiencies in the fanconi anemia DNA damage response pathway increase sensitivity to HPV-associated head and neck cancer. Cancer Research, 70, 9959–9968. Roxo, Jr, F., Arruda, L.K., Nagao, A.T., Carneiro-Sampaio, M.M. & Ferriani, V.P. (2001) Allergic and immunologic parameters in patients with fanconi’s anemia. International Archives of Allergy and Immunology, 125, 349 –355. Sehr, P., Muller, M., Hopfl, R., Widschwendter, A. & Pawlita, M. (2002) HPV antibody detection by ELISA with capsid protein L1 fused to gluta- thione S-transferase. Journal of Virological Meth- ods, 106, 61–70. Sejas, D.P., Rani, R., Qiu, Y., Zhang, X., Fagerlie, S.R., Nakano, H., Williams, D.A. & Pang, Q. (2007) Inflammatory reactive oxygen species- mediated hemopoietic suppression in fancc-defi- cient mice. Journal of Immunology (Baltimore, Md.: 1950), 178, 5277–5287. Algorithm for initial management of priapism in chronic myeloid leukaemia Rodgers et al (2012) provided an excellent overview on the management of priapism, but we feel it is not sufficiently specific to the management of priapism as a presenting feature in chronic myeloid leukaemia (CML). Moreover, a review of this serious medical syndrome is likely to be of special relevance to resource-constrained regions of the world where CML frequently presents in advanced phases (Gupta et al, 1987; Tazi, 2009). Some of the diagnostic and thera- peutic recommendations described by Rodgers et al (2012) may be impractical as the required facilities, especially in the developing world, may not be readily available. Suspicion of priapism as a presenting feature of CML STEP 1 IV hydration and allopurinol Initiate hydroxycarbamide at 50–100 mg/kg/day Urgent consultation with Haematology, Urology, Apheresis Service and Haematopathology STEP 2: Simultaneous initiation of the following: General Measures: (a) WBC monitoring every 6 h (b) Oral sympathomimetics (c) Prophylactic anticoagulation (d) Local measures (ice, pain relief) Specific Chemotherapy Add TKI as soon as possible Leukapheresis Daily leukapheresis to achieve rapid leucocyte reduction Urological measures 1st Line - Corpus cavernosal aspiration 2nd Line - Intra-cavernosal injection of sympathomimetics 3rd Line - Corpus cavernosal shunt 4th Line - Penile prosthetic implant Fig 1. Emergency management of priapism as a presenting feature of CML. CML, chronic myeloid leukaemia; WBC, white blood cell count; TKI, tyrosine kinase inhibitor. Correspondence ª 2012 Blackwell Publishing Ltd British Journal of Haematology, 2012, 159, 237–255 250