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Prognostic scoring systems and comorbidities in chronic myelomonocytic leukaemia: a nationwide population-based study

Daniel Moreno Berggren1, Matilda Kjellander2, Ellen Backlund1

  • 1Department of Medical Science, Section of Hematology, Uppsala University, Uppsala, Sweden.

British Journal of Haematology
|June 6, 2020
PubMed

Insights

Prognostic models like the Charlson Comorbidity Index (CCI) and CMML-specific prognostic scoring system (CPSS) best predict survival in chronic myelomonocytic leukemia (CMML). Autoimmune conditions are also more common in CMML patients.

Area of Science:

  • Hematology
  • Oncology
  • Epidemiology

Background:

  • Outcomes in chronic myelomonocytic leukemia (CMML) are highly variable.
  • Comorbidities significantly impact patient survival and treatment decisions.
  • Accurate prognostic models and comorbidity indices are crucial for personalized CMML management.

Purpose of the Study:

  • To assess comorbidities in a nationwide CMML cohort.
  • To validate existing comorbidity indices for CMML.
  • To compare the prognostic power of various scoring systems in CMML.

Main Methods:

  • Nationwide population-based study of 337 CMML patients diagnosed between 2009-2015.
  • Validation of Charlson Comorbidity Index (CCI), Haematopoietic cell transplantation-specific Comorbidity Index (HCT-CI), and Myelodysplastic Syndrome-Specific Comorbidity Index (MDS-CI).
  • Comparison of prognostic scoring systems: revised International Prognostic Scoring System (IPSS-R), CMML-specific prognostic scoring system (CPSS), MD Anderson Prognostic Scoring System (MDAPS), and Mayo score.

Main Results:

  • Median overall survival was 21.3 months.
  • Autoimmune conditions (e.g., polymyalgia rheumatica, Hashimoto's thyroiditis) were present in 25% of patients.
  • CCI demonstrated the highest C-index (0.62) among comorbidity indices and was independently associated with survival. CPSS showed the highest prognostic power (C-index 0.69) among scoring systems.

Conclusions:

  • The Charlson Comorbidity Index (CCI) and CMML-specific prognostic scoring system (CPSS) exhibit the strongest prognostic value in CMML using real-world data.
  • Autoimmune conditions are overrepresented in the CMML population.
  • Validated prognostic tools are essential for guiding individualized treatment strategies in CMML.

Keywords:
CMML-specific prognostic scoring system (CPSS)chronic myelomonocytic leukaemia (CMML)comorbidity indexpopulation-based studyprognostic scores

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