ISSN 1866-8836
Клеточная терапия и трансплантация

MP-01. Features of therapeutic strategy in patients with CMML

Svetlana E. Durova, Nikita P. Volkov, Elena V. Morozova, Yulia Yu. Vlasova, Ivan S. Moiseev, Alexander D. Kulagin

RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia


Contact: Dr. Svetlana E. Durova, e-mail: svet.durova2015@yandex.ru

doi 10.18620/ctt-1866-8836-2023-12-3-1-176

Summary

Chronic myelomonocytic leukemia (CMML) is a chronic myeloproliferative disease characterized by dysplasia of peripheral blood and bone marrow cells, excessive production and circulation of monocytes in peripheral blood and the risk of transformation into acute myeloid leukemia (AML). The only curative method is allogeneic hematopoietic stem cell transplantation (allo-HSCT). The aim of the work was to describe a group of patients diagnosed with CMML and evaluate the results of therapy.

Patients and methods

The retrospective study included 78 patients with a verified diagnosis of CMML observed at the RM Gorbacheva Research Institute. The group consisted, mainly, of males (71%, n=55). The survival analysis was performed using the Kaplan-Meier method, the assessment of risk factors affecting survival was performed by the Cox regression method.

Results

The median age at the time of diagnosis was 56 years (17-88). Overall survival (OS) for the entire population was 50% (95% CI 30.9-80.1%), median 24 months. At the time of diagnosis, 27% of patients (n=21) were staged according to the 2016 WHO classification as CMML-0; CMML-1 (22%, n=17), and 51% (n=40) were CMML-2. During the follow-up, transformation into acute myeloid leukemia (AML) was recorded in 33% of patients (n=26). The average time to transformation into AML from the moment of diagnosis was 11 months. Upon analysis of the factors affecting OS, the worst prognosis was shown by patients with bone marrow blast counts at the onset of the disease of 4% or more (CI95% 18.5-58.2%, p=0.088), as well as patients with a registered transformation into AML (HR=2.01, p=0.06). Allo-HSCT was performed in 26% (n=20) of patients, 65% of them (n=13) were at the stage of transformation into AML. The OS of 25% (n=5) patients who underwent allo-HSCT in complete remission (CR) for the underlying disease was 100% during the first year after transplantation. Among the patients in whom CR was not achieved during the first year after allo-HSCT, these values were 28% (CI95% 11.1-71.8%, p=0.018). The 2-year OS of patients diagnosed with CMML-2 at the onset of the disease who underwent allo-HSCT was 62% (CI95%; 43.3-89.1%), for patients diagnosed with CMML-2 who did not undergo allo-HSCT – 28% (CI95%; 13.1-59.5%, p=0.026). The median OS of patients after allo-HSCT was 9.5 months. The main causes of fatal outcomes of patients after allo-HSCT were: recurrence of the underlying disease in 55% (n=6), primary non-engraftment in 18%, and infectious complications in 18% of cases.

Conclusion

The results of therapy of patients diagnosed with CMML remain unsatisfactory.

Allo-HSCT is a curative method for the treatment of patients with CMML-2, however, it is necessary to study the progression predictors and determine the optimal time for the operation.

Keywords

Chronic myelomonocytic leukemia, allogeneic hematopoietic stem cell transplantation, transformation, acute myeloid leukemia.


Supplement 12-3
09/30/2023

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doi 10.18620/ctt-1866-8836-2023-12-3-1-176

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