COMBINATION OF HEMOGLOBIN LEVEL AT PRESENTATION WITH MOLECULAR RESPONSE AT 3 MONTHS BETTER PREDICTS SURVIVALS AND DEEP MOLECULAR RESPONSE TO IMATINIB IN CHRONIC-PHASE CHRONIC MYELOID LEUKEMIA PATIENTS
(Abstract release date: 05/19/16)
EHA Library. Ko P. 06/09/16; 134728; PB1828
Mr. Po-Shen Ko
Contributions
Contributions
Abstract
Abstract: PB1828
Type: Publication Only
Background
Anemia at presentation is not uncommon in newly diagnosed chronic-phase chronic myeloid leukemia(CP-CML). However, hemoglobin level at diagnosis of CP-CML is not included in the formulas for calculating three scoring systems, namely Sokal, Hasford and EUTOS scores, for predicting survival outcomes. To our best knowledge, studies on the prognostic values of hemogobin levels at diagnosis of CP-CML were scarce, especially in association with survial outcomes and treatment responses.
Aims
We retrospetively collected data from consecutively newly diagnosed CP-CML patients treated with Imatinib to explore the value of hemoglobin level at presentaiton in predicting survival outcomes and treamtment responses as compared with current scoring systems.
Methods
A cohort of 154 newly diagnosed CML-CP patients treated with frontline Imatinib was surveyed retrospectively from January 2001 to April 2014. The cut-off value of baseline hemoglobin (Hb) level at diagnosis was defined as 10.0 g/dl arbitrarily. The influence of severe anemia (Hb<10.0 g/dl) and three CML scoring systems (Sokal, Hasford, and EUTOS) at diagnosis on treatment response landmarks, progression-free survival (PFS), event-free survival (EFS) and overall survival (OS), were examined by univariate and multivariate analyses. The discriminatory abilities of three prognostic models and baseline characteristics were examined by using the Cox proportional hazards model, and the consequences of the Cox model were expressed with the Akaike information criterion (AIC), which revealed how the EFS, PFS and OS were affected. The model with lower AIC is more explanatory and informative.
Results
Severe anemia with Hb<10.0 g/dl was identified in 43 (27.9%) of 154 newly diagnosed CP-CML patients treated with Imatinib. Patients with Hb<10.0 g/dl was associated with splenomegaly (76.7% vs 52.3%, p=0.006), high EUTOS risk (37.2% vs 16.2%, p=0.005), high Sokal score (48.8% vs 22.5%, p=0.001), high Hasford score (27.9% vs 7.2%, p=0.001), additional chromosomal abnormalities (25.6% vs 12.6%, p=0.049) but not associated with gender. Hb<10.0 g/dl was associated with higher white blood cell count (median=177.4 vs 88.6, p<0.001), blast percentage in peripheral blood (PB)(median=2.0% vs 1.0%, p=0.002), and eosinophil percentage in PB (3.0% vs 2.0%, p=0.038), but not assciated with MCV, basophil percentage in PB or platelet counts. Patients with Hb<10.0 g/dl had less favorable treatment responses including BCR-ABL≦10% at 3 months (51.2% vs 68.5% in Hb≧10.0 g/dl, p=0.045), complete cytogenetic response at 6 months (19.0% vs 50.5% in Hb≧10.0 g/dl, p<0.001), and major molecular response at 12 months (22.5% vs 45.2%in Hb≧10.0 g/dl, p=0.009). Furthermore, Hb at 10.0 g/dl could significantly distinguish EFS, PFS and OS with lower AIC value as compared with EUTOS, Hasford and Sokal scores. Moreover, combination of BCR-ABL≦10% at 3 months with Hb≧10.0 g/dl at presentation, it could predict the patients with better EFS, PFS, and OS and deeper molercular responses (MR4.5).
Conclusion
Severe anemia (Hb<10.0 g/dl) at presentation was associated with less favorable treatment responses, poor EFS, PFS and OS in newly diagnosed CP-CML patients treated with frontline Imatinib. Combination of Hb≧ 10.0 g/dl at presentation with early molecular resposne (BCR-ABL≦10%) a 3 months, it could better predict survival outcomes and cumulative incidence of deep molecular response (MR4.5) as compared with current three scoring systems. Our study highlights the need for revisiting traditional CML scoring systems in the TKI era and suggests that CP-CML patients with Hb level≧ 10.0 g/dl at presentation and with early molecular response at 3 months might respond to Imatinib well thereafter.
Session topic: E-poster
Keyword(s): Anemia, Chronic myeloid leukemia, Molecular response, Survival prediction
Type: Publication Only
Background
Anemia at presentation is not uncommon in newly diagnosed chronic-phase chronic myeloid leukemia(CP-CML). However, hemoglobin level at diagnosis of CP-CML is not included in the formulas for calculating three scoring systems, namely Sokal, Hasford and EUTOS scores, for predicting survival outcomes. To our best knowledge, studies on the prognostic values of hemogobin levels at diagnosis of CP-CML were scarce, especially in association with survial outcomes and treatment responses.
Aims
We retrospetively collected data from consecutively newly diagnosed CP-CML patients treated with Imatinib to explore the value of hemoglobin level at presentaiton in predicting survival outcomes and treamtment responses as compared with current scoring systems.
Methods
A cohort of 154 newly diagnosed CML-CP patients treated with frontline Imatinib was surveyed retrospectively from January 2001 to April 2014. The cut-off value of baseline hemoglobin (Hb) level at diagnosis was defined as 10.0 g/dl arbitrarily. The influence of severe anemia (Hb<10.0 g/dl) and three CML scoring systems (Sokal, Hasford, and EUTOS) at diagnosis on treatment response landmarks, progression-free survival (PFS), event-free survival (EFS) and overall survival (OS), were examined by univariate and multivariate analyses. The discriminatory abilities of three prognostic models and baseline characteristics were examined by using the Cox proportional hazards model, and the consequences of the Cox model were expressed with the Akaike information criterion (AIC), which revealed how the EFS, PFS and OS were affected. The model with lower AIC is more explanatory and informative.
Results
Severe anemia with Hb<10.0 g/dl was identified in 43 (27.9%) of 154 newly diagnosed CP-CML patients treated with Imatinib. Patients with Hb<10.0 g/dl was associated with splenomegaly (76.7% vs 52.3%, p=0.006), high EUTOS risk (37.2% vs 16.2%, p=0.005), high Sokal score (48.8% vs 22.5%, p=0.001), high Hasford score (27.9% vs 7.2%, p=0.001), additional chromosomal abnormalities (25.6% vs 12.6%, p=0.049) but not associated with gender. Hb<10.0 g/dl was associated with higher white blood cell count (median=177.4 vs 88.6, p<0.001), blast percentage in peripheral blood (PB)(median=2.0% vs 1.0%, p=0.002), and eosinophil percentage in PB (3.0% vs 2.0%, p=0.038), but not assciated with MCV, basophil percentage in PB or platelet counts. Patients with Hb<10.0 g/dl had less favorable treatment responses including BCR-ABL≦10% at 3 months (51.2% vs 68.5% in Hb≧10.0 g/dl, p=0.045), complete cytogenetic response at 6 months (19.0% vs 50.5% in Hb≧10.0 g/dl, p<0.001), and major molecular response at 12 months (22.5% vs 45.2%in Hb≧10.0 g/dl, p=0.009). Furthermore, Hb at 10.0 g/dl could significantly distinguish EFS, PFS and OS with lower AIC value as compared with EUTOS, Hasford and Sokal scores. Moreover, combination of BCR-ABL≦10% at 3 months with Hb≧10.0 g/dl at presentation, it could predict the patients with better EFS, PFS, and OS and deeper molercular responses (MR4.5).
Conclusion
Severe anemia (Hb<10.0 g/dl) at presentation was associated with less favorable treatment responses, poor EFS, PFS and OS in newly diagnosed CP-CML patients treated with frontline Imatinib. Combination of Hb≧ 10.0 g/dl at presentation with early molecular resposne (BCR-ABL≦10%) a 3 months, it could better predict survival outcomes and cumulative incidence of deep molecular response (MR4.5) as compared with current three scoring systems. Our study highlights the need for revisiting traditional CML scoring systems in the TKI era and suggests that CP-CML patients with Hb level≧ 10.0 g/dl at presentation and with early molecular response at 3 months might respond to Imatinib well thereafter.
Session topic: E-poster
Keyword(s): Anemia, Chronic myeloid leukemia, Molecular response, Survival prediction
Abstract: PB1828
Type: Publication Only
Background
Anemia at presentation is not uncommon in newly diagnosed chronic-phase chronic myeloid leukemia(CP-CML). However, hemoglobin level at diagnosis of CP-CML is not included in the formulas for calculating three scoring systems, namely Sokal, Hasford and EUTOS scores, for predicting survival outcomes. To our best knowledge, studies on the prognostic values of hemogobin levels at diagnosis of CP-CML were scarce, especially in association with survial outcomes and treatment responses.
Aims
We retrospetively collected data from consecutively newly diagnosed CP-CML patients treated with Imatinib to explore the value of hemoglobin level at presentaiton in predicting survival outcomes and treamtment responses as compared with current scoring systems.
Methods
A cohort of 154 newly diagnosed CML-CP patients treated with frontline Imatinib was surveyed retrospectively from January 2001 to April 2014. The cut-off value of baseline hemoglobin (Hb) level at diagnosis was defined as 10.0 g/dl arbitrarily. The influence of severe anemia (Hb<10.0 g/dl) and three CML scoring systems (Sokal, Hasford, and EUTOS) at diagnosis on treatment response landmarks, progression-free survival (PFS), event-free survival (EFS) and overall survival (OS), were examined by univariate and multivariate analyses. The discriminatory abilities of three prognostic models and baseline characteristics were examined by using the Cox proportional hazards model, and the consequences of the Cox model were expressed with the Akaike information criterion (AIC), which revealed how the EFS, PFS and OS were affected. The model with lower AIC is more explanatory and informative.
Results
Severe anemia with Hb<10.0 g/dl was identified in 43 (27.9%) of 154 newly diagnosed CP-CML patients treated with Imatinib. Patients with Hb<10.0 g/dl was associated with splenomegaly (76.7% vs 52.3%, p=0.006), high EUTOS risk (37.2% vs 16.2%, p=0.005), high Sokal score (48.8% vs 22.5%, p=0.001), high Hasford score (27.9% vs 7.2%, p=0.001), additional chromosomal abnormalities (25.6% vs 12.6%, p=0.049) but not associated with gender. Hb<10.0 g/dl was associated with higher white blood cell count (median=177.4 vs 88.6, p<0.001), blast percentage in peripheral blood (PB)(median=2.0% vs 1.0%, p=0.002), and eosinophil percentage in PB (3.0% vs 2.0%, p=0.038), but not assciated with MCV, basophil percentage in PB or platelet counts. Patients with Hb<10.0 g/dl had less favorable treatment responses including BCR-ABL≦10% at 3 months (51.2% vs 68.5% in Hb≧10.0 g/dl, p=0.045), complete cytogenetic response at 6 months (19.0% vs 50.5% in Hb≧10.0 g/dl, p<0.001), and major molecular response at 12 months (22.5% vs 45.2%in Hb≧10.0 g/dl, p=0.009). Furthermore, Hb at 10.0 g/dl could significantly distinguish EFS, PFS and OS with lower AIC value as compared with EUTOS, Hasford and Sokal scores. Moreover, combination of BCR-ABL≦10% at 3 months with Hb≧10.0 g/dl at presentation, it could predict the patients with better EFS, PFS, and OS and deeper molercular responses (MR4.5).
Conclusion
Severe anemia (Hb<10.0 g/dl) at presentation was associated with less favorable treatment responses, poor EFS, PFS and OS in newly diagnosed CP-CML patients treated with frontline Imatinib. Combination of Hb≧ 10.0 g/dl at presentation with early molecular resposne (BCR-ABL≦10%) a 3 months, it could better predict survival outcomes and cumulative incidence of deep molecular response (MR4.5) as compared with current three scoring systems. Our study highlights the need for revisiting traditional CML scoring systems in the TKI era and suggests that CP-CML patients with Hb level≧ 10.0 g/dl at presentation and with early molecular response at 3 months might respond to Imatinib well thereafter.
Session topic: E-poster
Keyword(s): Anemia, Chronic myeloid leukemia, Molecular response, Survival prediction
Type: Publication Only
Background
Anemia at presentation is not uncommon in newly diagnosed chronic-phase chronic myeloid leukemia(CP-CML). However, hemoglobin level at diagnosis of CP-CML is not included in the formulas for calculating three scoring systems, namely Sokal, Hasford and EUTOS scores, for predicting survival outcomes. To our best knowledge, studies on the prognostic values of hemogobin levels at diagnosis of CP-CML were scarce, especially in association with survial outcomes and treatment responses.
Aims
We retrospetively collected data from consecutively newly diagnosed CP-CML patients treated with Imatinib to explore the value of hemoglobin level at presentaiton in predicting survival outcomes and treamtment responses as compared with current scoring systems.
Methods
A cohort of 154 newly diagnosed CML-CP patients treated with frontline Imatinib was surveyed retrospectively from January 2001 to April 2014. The cut-off value of baseline hemoglobin (Hb) level at diagnosis was defined as 10.0 g/dl arbitrarily. The influence of severe anemia (Hb<10.0 g/dl) and three CML scoring systems (Sokal, Hasford, and EUTOS) at diagnosis on treatment response landmarks, progression-free survival (PFS), event-free survival (EFS) and overall survival (OS), were examined by univariate and multivariate analyses. The discriminatory abilities of three prognostic models and baseline characteristics were examined by using the Cox proportional hazards model, and the consequences of the Cox model were expressed with the Akaike information criterion (AIC), which revealed how the EFS, PFS and OS were affected. The model with lower AIC is more explanatory and informative.
Results
Severe anemia with Hb<10.0 g/dl was identified in 43 (27.9%) of 154 newly diagnosed CP-CML patients treated with Imatinib. Patients with Hb<10.0 g/dl was associated with splenomegaly (76.7% vs 52.3%, p=0.006), high EUTOS risk (37.2% vs 16.2%, p=0.005), high Sokal score (48.8% vs 22.5%, p=0.001), high Hasford score (27.9% vs 7.2%, p=0.001), additional chromosomal abnormalities (25.6% vs 12.6%, p=0.049) but not associated with gender. Hb<10.0 g/dl was associated with higher white blood cell count (median=177.4 vs 88.6, p<0.001), blast percentage in peripheral blood (PB)(median=2.0% vs 1.0%, p=0.002), and eosinophil percentage in PB (3.0% vs 2.0%, p=0.038), but not assciated with MCV, basophil percentage in PB or platelet counts. Patients with Hb<10.0 g/dl had less favorable treatment responses including BCR-ABL≦10% at 3 months (51.2% vs 68.5% in Hb≧10.0 g/dl, p=0.045), complete cytogenetic response at 6 months (19.0% vs 50.5% in Hb≧10.0 g/dl, p<0.001), and major molecular response at 12 months (22.5% vs 45.2%in Hb≧10.0 g/dl, p=0.009). Furthermore, Hb at 10.0 g/dl could significantly distinguish EFS, PFS and OS with lower AIC value as compared with EUTOS, Hasford and Sokal scores. Moreover, combination of BCR-ABL≦10% at 3 months with Hb≧10.0 g/dl at presentation, it could predict the patients with better EFS, PFS, and OS and deeper molercular responses (MR4.5).
Conclusion
Severe anemia (Hb<10.0 g/dl) at presentation was associated with less favorable treatment responses, poor EFS, PFS and OS in newly diagnosed CP-CML patients treated with frontline Imatinib. Combination of Hb≧ 10.0 g/dl at presentation with early molecular resposne (BCR-ABL≦10%) a 3 months, it could better predict survival outcomes and cumulative incidence of deep molecular response (MR4.5) as compared with current three scoring systems. Our study highlights the need for revisiting traditional CML scoring systems in the TKI era and suggests that CP-CML patients with Hb level≧ 10.0 g/dl at presentation and with early molecular response at 3 months might respond to Imatinib well thereafter.
Session topic: E-poster
Keyword(s): Anemia, Chronic myeloid leukemia, Molecular response, Survival prediction
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