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. 2015 Sep;15(9):546-9.
doi: 10.1016/j.clml.2015.06.002. Epub 2015 Jun 18.

Patients With Therapy-Related CMML Have Shorter Median Overall Survival Than Those With De Novo CMML: Mayo Clinic Long-Term Follow-Up Experience

Salih Subari  1 , Mrinal Patnaik  1 , Dima Alfakara  1 , Naseema Gangat  1 , Michelle Elliott  1 , William Hogan  1 , Mark Litzow  1 , Aref Al-Kali  2
Affiliations

Patients With Therapy-Related CMML Have Shorter Median Overall Survival Than Those With De Novo CMML: Mayo Clinic Long-Term Follow-Up Experience

Salih Subari et al. Clin Lymphoma Myeloma Leuk. 2015 Sep.

Abstract

Background: Chronic myelomonocytic leukemia (CMML) is a malignant hematologic neoplasm characterized by peripheral blood monocytosis and bone marrow dysplasia. The World Health Organization classified therapy-related (t-) myeloid neoplasm (MN) as another category. It is known that t-MNs tend to have a worse prognosis than de novo (dn-) MN (dn-MN).

Patients and methods: Previous exposure to chemotherapy (CT), radiotherapy (RT), or both were defined as t-CMML and lack of both as dn-CMML.

Results: Of 265 CMML patients, 30 (11%) had t-CMML. Seventeen (57%) patients had previous exposure to CT, 6 (20%) to RT, and 7 (23%) to CT and RT. Leukemic transformation (LT) was seen in 5 (17%). In comparison, only lower platelet count was found to be statistically significant compared with dn-CMML. Median overall survival (OS) was 20 months in the dn-CMML group versus 11 months in the t-CMML group (P = .02). Median OS was 9 months in the CT group versus 4.4 months in the RT group versus 13 months in the CT and RT group (P = .7).

Conclusion: t-CMML comprises a small portion of all CMML cases (11%). Median OS in the dn-CMML group was longer than in the t-CMML group but LT seemed to be similar in terms of incidence and time to occurrence. Additional studies are needed to confirm our results.

Keywords: Chronic myelomonocytic leukemia; Hypomethylation; Leukemic transformation; Survival; Treatment-related.

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