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Multicenter Study
. 2021 Aug;107(2):265-274.
doi: 10.1111/ejh.13647. Epub 2021 Jun 1.

Impact of age on the cumulative risk of transformation in patients with chronic myelomonocytic leukaemia

Sigrid Machherndl-Spandl  1 , Eva Jäger  2 , Agnes Barna  3 , Michael Gurbisz  2 , Renate Marschon  4 , Temeida Graf  5 , Elmir Graf  5 , Christoph Geissler  6 , Gregor Hoermann  7   8 , Thomas Nösslinger  9 , Michael Pfeilstöcker  9 , Peter Bettelheim  1 , Otto Zach  4 , Ansgar Weltermann  1 , Sonja Heibl  10 , Josef Thaler  10 , Armin Zebisch  11   12 , Heinz Sill  11 , Reinhard Stauder  13 , Gerald Webersinke  4 , Rajko Kusec  13   14 , Ernst Ulsperger  15 , Bruno Schneeweiss  16 , Leopold Öhler  17 , Ulrich Germing  18 , Peter Valent  8   19 , Heinz Tüchler  9 , Klaus Geissler  5   20
Affiliations
Multicenter Study

Impact of age on the cumulative risk of transformation in patients with chronic myelomonocytic leukaemia

Sigrid Machherndl-Spandl et al. Eur J Haematol. 2021 Aug.

Abstract

In older patients with chronic myelomonocytic leukaemia (CMML) and limited life expectancy due to age and or comorbidities, it is particularly important to consider the risk of transformation for individualised treatment decisions. There is limited information on potential differences between younger and older CMML patients regarding the cumulative risk of transformation as well as haematological, molecular and biologic characteristics. We analysed data from the Austrian Biodatabase for CMML (ABCMML) to compare these parameters in 518 CMML patients. Categorisation of patients into 3 age-related groups: <60 years, 60-79 years and ≥80 years, showed a significantly lower risk of transformation at higher age by competing risk analysis, with a 4-year risk of 39%, 23% and 13%, respectively (P < .0001). The lower probability of transformation was associated with a lower percentage of blast cells in the peripheral blood (PB) of older patients. Furthermore, we provide a simple score based on age, PB blasts and platelet counts that allowed us to define subgroups of CMML patients with a different cumulative transformation risk, including a low-risk group with a transformation risk of only 5%. Our findings may facilitate reasonable treatment decisions in elderly patients with CMML.

Keywords: age; blast cell count; chronic myelomonocytic leukaemia; cytogenetics; mutations; score.

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Conflict of interest statement

The authors declare that they have no conflict of interest to disclose in this study.

Figures

FIGURE 1
FIGURE 1
Functional form of the relation between age and risk of transformation. The black curve illustrates the (log)‐linear relation of age to the risk of transformation. The green line shows the risk, adjusted by stratification for the Mayo score, WBC, cytogenetic risk, and ASXL1 to account for confounding of these variables, the blue line shows the risk for three age categories (stratified as above). The grey dotted line sketches the age distribution of the patients (on linear scales)
FIGURE 2
FIGURE 2
Leukaemia‐free time by age estimated by competing risk analyses. A, Proportion transformed. B, Proportion dead without AML
FIGURE 3
FIGURE 3
A, B, Leukaemia‐free time by ART score depending on three risk categories. A, Proportion transformed. B, Proportion dead without AML
See this image and copyright information in PMC

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