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Prognostic value of a new clinically-based classification system in patients with CMML undergoing allogeneic HCT: a
Francesco Onida1, Giulia Sbianchi2, Aleksandar Radujkovic3
1Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico-University of Milan, Milan, Italy. francesco.onida@unimi.it.
Insights
A new classification for chronic myelomonocytic leukemia (CMML) identifies Myelodysplastic (MD)-CMML as a low-risk group, showing improved survival after stem cell transplant. The WHO classification remains superior for identifying high-risk CMML-2 patients.
Area of Science:
- Hematology
- Oncology
- Clinical Medicine
Background:
- Chronic Myelomonocytic Leukemia (CMML) is a heterogeneous clonal hematopoietic stem cell disorder.
- Accurate prognostic stratification is crucial for guiding treatment decisions in CMML.
- A new International Consortium classification stratifies CMML into Myelodysplastic (MD)-CMML, MD/MP (overlap)-CMML, and Myeloproliferative (MP)-CMML groups.
Purpose of the Study:
- To evaluate the impact of the new three-group CMML classification on allogeneic hematopoietic stem cell transplantation (allo-HCT) outcomes.
- To compare the prognostic value of the new classification with the conventional World Health Organization (WHO) classification for CMML.
Main Methods:
- Analysis of 151 CMML patients who underwent allo-HCT between 1997 and 2016, using data from the European Society for Blood and Marrow Transplantation (EBMT) Registry.
- Patients were classified at the time of transplantation based on the new three-group system (MD-CMML, MD/MP-CMML, MP-CMML), using peripheral blasts instead of immature myeloid cells (IMC).
- Comparison of outcomes, including complete remission (CR) rate and progression-free survival (PFS), between the new classification groups and against the WHO classification (CMML-0, CMML-1, CMML-2).
Main Results:
- The new classification categorized patients as MD-CMML (38%), MD/MP-CMML (42%), and MP-CMML (20%).
- MD-CMML patients represented a low-risk group with a higher CR rate at transplant and significantly longer 2-year post-transplant progression-free survival (44.5%) compared to other groups (33.5%).
- The WHO classification demonstrated superiority in identifying high-risk CMML-2 patients with poorer survival outcomes.
Conclusions:
- The new three-group CMML classification effectively stratifies patients undergoing allo-HCT, identifying MD-CMML as a favorable prognostic group.
- While the new classification offers valuable insights, the conventional WHO classification remains essential for identifying high-risk CMML patients.
- Further validation of the new classification in larger cohorts is warranted to refine CMML prognostication and treatment strategies.
Abstract:
Recently a new three-group clinical classification was reported by an International Consortium to stratify CMML patients with regard to prognosis. The groups were defined as follows: (1) Myelodysplastic (MD)-CMML: WBC ≤ 10 × 109/l, circulating immature myeloid cells (IMC) = 0, no splenomegaly; (2) MD/MP (overlap)-CMML: WBC 10-20 × 109/l or WBC ≤ 10 × 109/l but IMC > 0 and/or splenomegaly; (3) Myeloproliferative (MP)-CMML: WBC > 20 × 109/l. By analysing EBMT Registry patients who underwent allo-HCT for CMML between 1997 and 2016, we aimed to determine the impact of this classification on transplantation outcome and to make a comparison with the conventional WHO classification (CMML-0/CMML-1/CMML-2). Patient grouping was based on the data registered at time of transplantation, with IMC replaced by peripheral blasts. Among 151 patients included in the analysis, 38% were classified as MD-CMML, 42% as MD/MP-CMML and 20% as MP-CMML. With a median survival of 17 months in the whole series, MD-CMML patients were distinguished as a low-risk group with higher CR rate at transplant and a longer post-transplant 2-year progression-free survival in comparison to others (44.5% vs 33.5%, respectively), whereas the WHO classification was superior in identifying high-risk patients (CMML-2) with inferior survival outcomes.
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