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Prognostic assessment for chronic myelomonocytic leukemia in the context of the World Health Organization 2016 proposal: a multicenter study of 280 patients

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Abstract

Knowledge on chronic myelomonocytic leukemia (CMML) patients from Argentina and Brazil is limited. Our series of 280 patients depicted an older age at diagnosis (median 72 years old), 26% of aberrant karyotypes, and a prevalence of myelodysplastic (60%) and CMML-0 subtypes (56%). The median overall survival (OS) was 48.2 months for patients in CMML-0 (Ref.), 24.7 months for those in CMML-1 (HR = 2.0, p = 0.001), and 8.8 months for patients in CMML-2 (HR = 4.6, p < 0.001). In the CMML-0 category, median OS were different between myelodysplastic and myeloproliferative subtypes (63.7 vs 21.2 months, p < 0.001); however, no differences were observed within CMML-1 and CMML-2 subtypes (24.7 vs 23.7 months, p = 0.540, and 9.1 vs 8.2 months, p = 0.160). The prognostic impact of 24 variables and 7 prognostic systems was adjusted to the WHO 2016 after validating their usefulness. Multivariate analysis were performed, and the final model revealed Hb ≥ 8 -< 10g/dL (HR 1.7), Hb < 8g/dL (HR 2.8), poor karyotypes (HR 2.1), WHO 2016-CMML-1 (HR 2.1), and CMML-2 (HR 3.5) as independent adverse clinical parameters in our cohort with a borderline influence of platelets count < 50 × 109/L (HR 1.4). We could validate several scoring systems, the WHO 2016 proposal and its prognostic capability, along with accessible covariates, on predicting the outcome in our series of CMML patients from Latin America.

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Acknowledgements

On behalf of the Grupo de Estudio de SMD, Sociedad Argentina de Hematología, Buenos Aires, Argentina, and the Grupo Latinoamericano de Mielodisplasia (GLAM), the authors thank the investigators of the Argentinean MDS’s Study Group organized by the Argentinean Society of Hematology for the use of the MDS Registry database.

Availability of data and materials

The dataset generated and analyzed during the current study are available from the corresponding author on request.

Funding

This work was not specifically supported, but CB receives grants from the Agencia Nacional de Promoción Científica y Tecnológica (ANPCyT) [PICT 0480 and PICT 1623] and from the Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) [PIP 0056].

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Authors and Affiliations

  1. Servicio de Hematología, Hospital General de Agudos “C Durand”, Buenos Aires, Argentina

    Jacqueline S. González & Viviana Novoa

  2. Servicio de Hematología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    María Agustina Perusini, Dorotea Fantl, Elsa Nucifora & Jorge Arbelbide

  3. Servicio de Hematología, Hospital Universitario Privado de Córdoba, Córdoba, Argentina

    Ana L. Basquiera

  4. Departamento de Hematología, Hospital Nacional “A. J. Posadas”, El Palomar, Argentina

    Graciela Alfonso

  5. Hospital das Clínicas, Facultad de Medicina, Universidade Sao Paulo, Sao Paulo, Brazil

    Walter Macedo Lima, Marcela Cavalcanti de Andrade Silva, Vanderson Rocha & Elvira D. R. P. Velloso

  6. Servicio de Hematología, Hospital Interzonal de Agudos “Dr. Diego Paroissien”, Isidro Casanova, Argentina

    Carolina Lazzarino

  7. Laboratorio de Genética Hematológica, Instituto de Medicina Experimental (IMEX-CONICET)/Academia Nacional de Medicina, Buenos Aires, Argentina

    Irene B. Larripa & Carolina B. Belli

Authors
  1. Jacqueline S. González
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  2. María Agustina Perusini
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  3. Ana L. Basquiera
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  4. Graciela Alfonso
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  6. Walter Macedo Lima
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  7. Elsa Nucifora
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  8. Carolina Lazzarino
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  9. Viviana Novoa
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  10. Marcela Cavalcanti de Andrade Silva
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  11. Irene B. Larripa
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  12. Vanderson Rocha
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  14. Elvira D. R. P. Velloso
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  15. Carolina B. Belli
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Corresponding author

Correspondence to Jacqueline S. González.

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Ethics approval statement

All procedures performed in studies involving the patient were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the Institutos de la Academia Nacional de Medicina. Informed consent was obtained according to institutional guidelines.

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González, J.S., Perusini, M.A., Basquiera, A.L. et al. Prognostic assessment for chronic myelomonocytic leukemia in the context of the World Health Organization 2016 proposal: a multicenter study of 280 patients. Ann Hematol 100, 1439–1449 (2021). https://doi.org/10.1007/s00277-021-04539-3

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  • DOI: https://doi.org/10.1007/s00277-021-04539-3

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