PROGNOSTIC FACTORS IN CHRONIC MYELOMONOCYTIC LEUKEMIA FROM SOUTH AMERICA
(Abstract release date: 05/19/16)
EHA Library. Gonzalez J. 06/09/16; 134816; PB1916
Dr. Jacqueline Gonzalez
Contributions
Contributions
Abstract
Abstract: PB1916
Type: Publication Only
Background
INTRODUCTION Chronic myelomonocytic leukemia (CMML) is a clonal hematologicdisorder sharing features of myelodysplastic syndromes (MDS)and chronic myeloproliferative (MP) disorders.The International ScoringPrognostic System (IPSS) for MDS and its recent revision (IPSS-R)excluded CMML-MP cases. Thus, the CPSS (CMML Prognostic Scoring System) was designed specifically for patients with CMML in 2013. Also, the German Group proposed to divide CMML-1 into: CMML-0 and CMML-1 according to the limit of <5% bone marrow blasts in 2014.However, both proposalshave not been widely reproduced.
Aims
To evaluate different prognostic factors for survival and evolution to AML, to validate the CPSS and to test the new proposed cut-point for BM blast in South American population with CMML de novo.
Methods
This is a multicenter analysis of 234 patients with de novo CMML from Argentina (152) and Brazil (82) diagnosed between March 1985 to December 2015. Clinical and hematologic data of patients was retrospectively collected and diagnosis of de novo CMML wasperformed according to WHO 2008 criteria.
Results
The CMML population showed a median age of 71 (range 15-95) years being 83% older than 60 years old, with a sex ratio M/F: 2.1. With a median overall survival of 31 months, 56 (24%) evolved to AML and 122 (52%) died. Table 1 shows the distribution of patients according to CMML-MD and CMML-MP subtypes; to WHO classification and to German proposal, karyotypes according to CPSS. Also, the different variants for the CPSS were calculated, including transfusion requirement, hemoglobin level limit of 10g/dL and the adjusted by gender. As it is shown, most of the prognostic parameters and all CPSS proposals were useful to predict outcome in our population (Kaplan Meier and log-rank, p<0.05). Since transfusion data was not available for most patients, only models including both hemoglobin cut-points were analyzed in multivariate analysis (Cox Regression, Backward-Stepwise method). The CPSS (hemoglobin threshold of 10 g/dL) sustained its independence both for survival [p<0.001, exp(B) 1.912] and evolution to AML [p<0.001, exp(B) 2.352]. Also LDH level and the German Proposal, not included in the original CPSS system, were analyzed in a multivariate model. This last cut-off for BM blast showed an additive value to predict survival and evolution to LMA [p=0.053 and p=0.003, exp(B) 1.335 and 2.057] when compared with the CPSS-Hb variant [p<0.001 and p=0.052, exp(B) 1.654 and 1.537]. Our results showed that the new proposed classification for CMML dividing them into CMML-0, -1 and -2 may add prognostic value to the CPSS.
Conclusion
Our results showed that the new proposed classification for CMML dividing them into CMML-0, -1 and -2 may add prognostic value to the CPSS.
Session topic: E-poster
Type: Publication Only
Background
INTRODUCTION Chronic myelomonocytic leukemia (CMML) is a clonal hematologicdisorder sharing features of myelodysplastic syndromes (MDS)and chronic myeloproliferative (MP) disorders.The International ScoringPrognostic System (IPSS) for MDS and its recent revision (IPSS-R)excluded CMML-MP cases. Thus, the CPSS (CMML Prognostic Scoring System) was designed specifically for patients with CMML in 2013. Also, the German Group proposed to divide CMML-1 into: CMML-0 and CMML-1 according to the limit of <5% bone marrow blasts in 2014.However, both proposalshave not been widely reproduced.
Aims
To evaluate different prognostic factors for survival and evolution to AML, to validate the CPSS and to test the new proposed cut-point for BM blast in South American population with CMML de novo.
Methods
This is a multicenter analysis of 234 patients with de novo CMML from Argentina (152) and Brazil (82) diagnosed between March 1985 to December 2015. Clinical and hematologic data of patients was retrospectively collected and diagnosis of de novo CMML wasperformed according to WHO 2008 criteria.
Results
The CMML population showed a median age of 71 (range 15-95) years being 83% older than 60 years old, with a sex ratio M/F: 2.1. With a median overall survival of 31 months, 56 (24%) evolved to AML and 122 (52%) died. Table 1 shows the distribution of patients according to CMML-MD and CMML-MP subtypes; to WHO classification and to German proposal, karyotypes according to CPSS. Also, the different variants for the CPSS were calculated, including transfusion requirement, hemoglobin level limit of 10g/dL and the adjusted by gender. As it is shown, most of the prognostic parameters and all CPSS proposals were useful to predict outcome in our population (Kaplan Meier and log-rank, p<0.05). Since transfusion data was not available for most patients, only models including both hemoglobin cut-points were analyzed in multivariate analysis (Cox Regression, Backward-Stepwise method). The CPSS (hemoglobin threshold of 10 g/dL) sustained its independence both for survival [p<0.001, exp(B) 1.912] and evolution to AML [p<0.001, exp(B) 2.352]. Also LDH level and the German Proposal, not included in the original CPSS system, were analyzed in a multivariate model. This last cut-off for BM blast showed an additive value to predict survival and evolution to LMA [p=0.053 and p=0.003, exp(B) 1.335 and 2.057] when compared with the CPSS-Hb variant [p<0.001 and p=0.052, exp(B) 1.654 and 1.537]. Our results showed that the new proposed classification for CMML dividing them into CMML-0, -1 and -2 may add prognostic value to the CPSS.
| Variable | N (%) | OS(50%, months) | P | Evolution to AML (months, 25%) | p | |
| Age | <60 yrs≥60 yrs | 38 (17)191 (83) | 2835 | =0.363 | 1231 | =0.001 |
| LDH | NormalElevated | 98 (54)83 (46) | 4226 | =0.062 | 9313 | =0.002 |
| Hb | ≥10g/dL<10g/dL | 126 (56)101 (44) | 5525 | <0.001 | 6611 | <0.001 |
| Hb | M ≥9 y F ≥8 g/dLM <9 y F <8 g/dL | 169 (75)58 (26) | 4016 | <0.001 | 319 | =0.001 |
| Plt | ≥100000/µL<100000/µL | 100 ( 45)125 (56) | 5425,1 | =0.003 | 5315 | =0.002 |
| Karyotypes-CPSS | GoodIntermediatePoor | 140 (73)20 (10)33 (17) | 503818 | <0.001 | 35199 | =0.001 |
| CMML | - MDS-MP | 132 (58)95 (42) | 4520 | <0.001 | 2714 | =0.244 |
| CMML | -0-1-2 | 124 (59)37 (18)48 (23) | 542411 | <0.001 | 93227 | <0.001 |
| Transfusion dependency | YesNo | 90 (69)40(31) | 24103 | =0.012 | 12NR | =0.002 |
| CPSS (transfusion dependency) | LowInt1Int2High | 17 (12)45 (33)61 (44)15 (11) | 105572312 | <0.001 | NR31135 | <0.001 |
| CPSS (Hb limit 10g/dL) | LowInt1Int2High | 53 (28)59 (31)63 (33)17 (9) | 99362312 | <0.001 | NR26.3137 | <0.001 |
| CPSS (Hb according to gender) | LowInt1Int2High | 64 (34)60 (31)56 (29)11 (6) | 99331518 | <0.001 | NR26123 | <0.001 |
Conclusion
Our results showed that the new proposed classification for CMML dividing them into CMML-0, -1 and -2 may add prognostic value to the CPSS.
Session topic: E-poster
Abstract: PB1916
Type: Publication Only
Background
INTRODUCTION Chronic myelomonocytic leukemia (CMML) is a clonal hematologicdisorder sharing features of myelodysplastic syndromes (MDS)and chronic myeloproliferative (MP) disorders.The International ScoringPrognostic System (IPSS) for MDS and its recent revision (IPSS-R)excluded CMML-MP cases. Thus, the CPSS (CMML Prognostic Scoring System) was designed specifically for patients with CMML in 2013. Also, the German Group proposed to divide CMML-1 into: CMML-0 and CMML-1 according to the limit of <5% bone marrow blasts in 2014.However, both proposalshave not been widely reproduced.
Aims
To evaluate different prognostic factors for survival and evolution to AML, to validate the CPSS and to test the new proposed cut-point for BM blast in South American population with CMML de novo.
Methods
This is a multicenter analysis of 234 patients with de novo CMML from Argentina (152) and Brazil (82) diagnosed between March 1985 to December 2015. Clinical and hematologic data of patients was retrospectively collected and diagnosis of de novo CMML wasperformed according to WHO 2008 criteria.
Results
The CMML population showed a median age of 71 (range 15-95) years being 83% older than 60 years old, with a sex ratio M/F: 2.1. With a median overall survival of 31 months, 56 (24%) evolved to AML and 122 (52%) died. Table 1 shows the distribution of patients according to CMML-MD and CMML-MP subtypes; to WHO classification and to German proposal, karyotypes according to CPSS. Also, the different variants for the CPSS were calculated, including transfusion requirement, hemoglobin level limit of 10g/dL and the adjusted by gender. As it is shown, most of the prognostic parameters and all CPSS proposals were useful to predict outcome in our population (Kaplan Meier and log-rank, p<0.05). Since transfusion data was not available for most patients, only models including both hemoglobin cut-points were analyzed in multivariate analysis (Cox Regression, Backward-Stepwise method). The CPSS (hemoglobin threshold of 10 g/dL) sustained its independence both for survival [p<0.001, exp(B) 1.912] and evolution to AML [p<0.001, exp(B) 2.352]. Also LDH level and the German Proposal, not included in the original CPSS system, were analyzed in a multivariate model. This last cut-off for BM blast showed an additive value to predict survival and evolution to LMA [p=0.053 and p=0.003, exp(B) 1.335 and 2.057] when compared with the CPSS-Hb variant [p<0.001 and p=0.052, exp(B) 1.654 and 1.537]. Our results showed that the new proposed classification for CMML dividing them into CMML-0, -1 and -2 may add prognostic value to the CPSS.
Conclusion
Our results showed that the new proposed classification for CMML dividing them into CMML-0, -1 and -2 may add prognostic value to the CPSS.
Session topic: E-poster
Type: Publication Only
Background
INTRODUCTION Chronic myelomonocytic leukemia (CMML) is a clonal hematologicdisorder sharing features of myelodysplastic syndromes (MDS)and chronic myeloproliferative (MP) disorders.The International ScoringPrognostic System (IPSS) for MDS and its recent revision (IPSS-R)excluded CMML-MP cases. Thus, the CPSS (CMML Prognostic Scoring System) was designed specifically for patients with CMML in 2013. Also, the German Group proposed to divide CMML-1 into: CMML-0 and CMML-1 according to the limit of <5% bone marrow blasts in 2014.However, both proposalshave not been widely reproduced.
Aims
To evaluate different prognostic factors for survival and evolution to AML, to validate the CPSS and to test the new proposed cut-point for BM blast in South American population with CMML de novo.
Methods
This is a multicenter analysis of 234 patients with de novo CMML from Argentina (152) and Brazil (82) diagnosed between March 1985 to December 2015. Clinical and hematologic data of patients was retrospectively collected and diagnosis of de novo CMML wasperformed according to WHO 2008 criteria.
Results
The CMML population showed a median age of 71 (range 15-95) years being 83% older than 60 years old, with a sex ratio M/F: 2.1. With a median overall survival of 31 months, 56 (24%) evolved to AML and 122 (52%) died. Table 1 shows the distribution of patients according to CMML-MD and CMML-MP subtypes; to WHO classification and to German proposal, karyotypes according to CPSS. Also, the different variants for the CPSS were calculated, including transfusion requirement, hemoglobin level limit of 10g/dL and the adjusted by gender. As it is shown, most of the prognostic parameters and all CPSS proposals were useful to predict outcome in our population (Kaplan Meier and log-rank, p<0.05). Since transfusion data was not available for most patients, only models including both hemoglobin cut-points were analyzed in multivariate analysis (Cox Regression, Backward-Stepwise method). The CPSS (hemoglobin threshold of 10 g/dL) sustained its independence both for survival [p<0.001, exp(B) 1.912] and evolution to AML [p<0.001, exp(B) 2.352]. Also LDH level and the German Proposal, not included in the original CPSS system, were analyzed in a multivariate model. This last cut-off for BM blast showed an additive value to predict survival and evolution to LMA [p=0.053 and p=0.003, exp(B) 1.335 and 2.057] when compared with the CPSS-Hb variant [p<0.001 and p=0.052, exp(B) 1.654 and 1.537]. Our results showed that the new proposed classification for CMML dividing them into CMML-0, -1 and -2 may add prognostic value to the CPSS.
| Variable | N (%) | OS(50%, months) | P | Evolution to AML (months, 25%) | p | |
| Age | <60 yrs≥60 yrs | 38 (17)191 (83) | 2835 | =0.363 | 1231 | =0.001 |
| LDH | NormalElevated | 98 (54)83 (46) | 4226 | =0.062 | 9313 | =0.002 |
| Hb | ≥10g/dL<10g/dL | 126 (56)101 (44) | 5525 | <0.001 | 6611 | <0.001 |
| Hb | M ≥9 y F ≥8 g/dLM <9 y F <8 g/dL | 169 (75)58 (26) | 4016 | <0.001 | 319 | =0.001 |
| Plt | ≥100000/µL<100000/µL | 100 ( 45)125 (56) | 5425,1 | =0.003 | 5315 | =0.002 |
| Karyotypes-CPSS | GoodIntermediatePoor | 140 (73)20 (10)33 (17) | 503818 | <0.001 | 35199 | =0.001 |
| CMML | - MDS-MP | 132 (58)95 (42) | 4520 | <0.001 | 2714 | =0.244 |
| CMML | -0-1-2 | 124 (59)37 (18)48 (23) | 542411 | <0.001 | 93227 | <0.001 |
| Transfusion dependency | YesNo | 90 (69)40(31) | 24103 | =0.012 | 12NR | =0.002 |
| CPSS (transfusion dependency) | LowInt1Int2High | 17 (12)45 (33)61 (44)15 (11) | 105572312 | <0.001 | NR31135 | <0.001 |
| CPSS (Hb limit 10g/dL) | LowInt1Int2High | 53 (28)59 (31)63 (33)17 (9) | 99362312 | <0.001 | NR26.3137 | <0.001 |
| CPSS (Hb according to gender) | LowInt1Int2High | 64 (34)60 (31)56 (29)11 (6) | 99331518 | <0.001 | NR26123 | <0.001 |
Conclusion
Our results showed that the new proposed classification for CMML dividing them into CMML-0, -1 and -2 may add prognostic value to the CPSS.
Session topic: E-poster
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