Role of allogeneic transplantation in chronic myelomonocytic leukemia: an international collaborative analysis
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Role of allogeneic transplantation in chronic myelomonocytic leukemia: an international collaborative analysis. / Robin, Marie; de Wreede, Liesbeth C; Padron, Eric; Bakunina, Katerina; Fenaux, Pierre; Koster, Linda; Nazha, Aziz; Beelen, Dietrich W; Rampal, Raajit K; Sockel, Katja; Komrokji, Rami S; Gagelmann, Nico; Eikema, Dirk-Jan; Radujkovic, Aleksandar; Finke, Jürgen; Potter, Victoria; Killick, Sally B; Legrand, Faezeh; Solary, Eric; Broom, Angus; Garcia-Manero, Guillermo; Rizzoli, Vittorio; Hayden, Patrick; Patnaik, Mrinal M; Onida, Francesco; Yakoub-Agha, Ibrahim; Itzykson, Raphael.
in: BLOOD, Jahrgang 140, Nr. 12, 22.09.2022, S. 1408-1418.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Role of allogeneic transplantation in chronic myelomonocytic leukemia: an international collaborative analysis
AU - Robin, Marie
AU - de Wreede, Liesbeth C
AU - Padron, Eric
AU - Bakunina, Katerina
AU - Fenaux, Pierre
AU - Koster, Linda
AU - Nazha, Aziz
AU - Beelen, Dietrich W
AU - Rampal, Raajit K
AU - Sockel, Katja
AU - Komrokji, Rami S
AU - Gagelmann, Nico
AU - Eikema, Dirk-Jan
AU - Radujkovic, Aleksandar
AU - Finke, Jürgen
AU - Potter, Victoria
AU - Killick, Sally B
AU - Legrand, Faezeh
AU - Solary, Eric
AU - Broom, Angus
AU - Garcia-Manero, Guillermo
AU - Rizzoli, Vittorio
AU - Hayden, Patrick
AU - Patnaik, Mrinal M
AU - Onida, Francesco
AU - Yakoub-Agha, Ibrahim
AU - Itzykson, Raphael
N1 - © 2022 by The American Society of Hematology.
PY - 2022/9/22
Y1 - 2022/9/22
N2 - To determine the survival benefit of allogeneic hematopoietic cell transplantation (allo-HCT) in chronic myelomonocytic leukemias (CMML), we assembled a retrospective cohort of CMML patients 18-70 years old diagnosed between 2000 and 2014 from an international CMML dataset (n = 730) and the EBMT registry (n = 384). The prognostic impact of allo-HCT was analyzed through univariable and multivariable time-dependent models and with a multistate model, accounting for age, sex, CMML prognostic scoring system (low or intermediate-1 grouped as lower-risk, intermediate-2 or high as higher-risk) at diagnosis, and AML transformation. In univariable analysis, lower-risk CMMLs had a 5-year overall survival (OS) of 20% with allo-HCT vs 42% without allo-HCT (P < .001). In higher-risk patients, 5-year OS was 27% with allo-HCT vs 15% without allo-HCT (P = .13). With multistate models, performing allo-HCT before AML transformation reduced OS in patients with lower-risk CMML, and a survival benefit was predicted for men with higher-risk CMML. In a multivariable analysis of lower-risk patients, performing allo-HCT before transformation to AML significantly increased the risk of death within 2 years of transplantation (hazard ratio [HR], 3.19; P < .001), with no significant change in long-term survival beyond this time point (HR, 0.98; P = .92). In higher-risk patients, allo-HCT significantly increased the risk of death in the first 2 years after transplant (HR 1.46; P = .01) but not beyond (HR, 0.60; P = .09). Performing allo-HCT before AML transformation decreases life expectancy in lower-risk patients but may be considered in higher-risk patients.
AB - To determine the survival benefit of allogeneic hematopoietic cell transplantation (allo-HCT) in chronic myelomonocytic leukemias (CMML), we assembled a retrospective cohort of CMML patients 18-70 years old diagnosed between 2000 and 2014 from an international CMML dataset (n = 730) and the EBMT registry (n = 384). The prognostic impact of allo-HCT was analyzed through univariable and multivariable time-dependent models and with a multistate model, accounting for age, sex, CMML prognostic scoring system (low or intermediate-1 grouped as lower-risk, intermediate-2 or high as higher-risk) at diagnosis, and AML transformation. In univariable analysis, lower-risk CMMLs had a 5-year overall survival (OS) of 20% with allo-HCT vs 42% without allo-HCT (P < .001). In higher-risk patients, 5-year OS was 27% with allo-HCT vs 15% without allo-HCT (P = .13). With multistate models, performing allo-HCT before AML transformation reduced OS in patients with lower-risk CMML, and a survival benefit was predicted for men with higher-risk CMML. In a multivariable analysis of lower-risk patients, performing allo-HCT before transformation to AML significantly increased the risk of death within 2 years of transplantation (hazard ratio [HR], 3.19; P < .001), with no significant change in long-term survival beyond this time point (HR, 0.98; P = .92). In higher-risk patients, allo-HCT significantly increased the risk of death in the first 2 years after transplant (HR 1.46; P = .01) but not beyond (HR, 0.60; P = .09). Performing allo-HCT before AML transformation decreases life expectancy in lower-risk patients but may be considered in higher-risk patients.
KW - Adolescent
KW - Adult
KW - Aged
KW - Hematopoietic Stem Cell Transplantation/adverse effects
KW - Humans
KW - Leukemia, Myelomonocytic, Chronic/diagnosis
KW - Leukemia, Myelomonocytic, Juvenile
KW - Male
KW - Middle Aged
KW - Retrospective Studies
KW - Transplantation, Homologous
KW - Young Adult
U2 - 10.1182/blood.2021015173
DO - 10.1182/blood.2021015173
M3 - SCORING: Journal article
C2 - 35667047
VL - 140
SP - 1408
EP - 1418
JO - BLOOD
JF - BLOOD
SN - 0006-4971
IS - 12
ER -
