Risk-Adjusted Comparison of Survival in Chronic Myelomonocytic Leukemia With and Without Allogeneic Stem Cell
Ali Alsugair1, Saubia Fathima1, Mohammad M Alhousani1
1Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Allogeneic stem cell transplant (ASCT) significantly improves survival for patients with chronic myelomonocytic leukemia (CMML), particularly those in high- and intermediate-risk groups. Early ASCT is recommended, regardless of genetic factors, to overcome adverse prognostic indicators.
Area of Science:
- Hematology
- Oncology
- Stem Cell Transplantation
Background:
- Chronic myelomonocytic leukemia (CMML) is a heterogeneous myeloid malignancy.
- The BLAST and BLAST-Mol risk models stratify CMML patients into distinct risk groups.
- Allogeneic stem cell transplant (ASCT) is a potentially curative option for CMML.
Purpose of the Study:
- To evaluate the survival impact of ASCT in a large cohort of CMML patients.
- To assess ASCT's efficacy across different risk strata defined by the BLAST and BLAST-Mol models.
- To determine if ASCT can overcome adverse prognostic factors in CMML.
Main Methods:
- Retrospective analysis of 775 consecutive CMML patients from Mayo Clinic.
- Comparison of overall survival (OS) between patients who underwent ASCT and those who did not.
- Survival analysis adjusted for baseline BLAST clinical and BLAST-Mol risk categories using time-dependent Cox models.
Main Results:
- ASCT was associated with significantly longer median OS (77 vs. 28 months; p < 0.01).
- This survival benefit was maintained after adjusting for BLAST and BLAST-Mol risk categories across high-, intermediate-, and low-risk groups.
- Time-dependent Cox models confirmed ASCT's favorable impact on survival for high- and intermediate-risk CMML patients.
Conclusions:
- ASCT provides a significant survival advantage for CMML patients, especially those in high- and intermediate-risk groups.
- ASCT can mitigate the negative prognostic impact of certain high-risk cytogenetic or molecular abnormalities.
- These findings support the consideration of early ASCT in CMML management, irrespective of genetic profile.
Abstract:
The recently published BLAST clinical risk model for chronic myelomonocytic leukemia (CMML) and its molecular version (BLAST-Mol) differentiate low, intermediate, and high-risk groups. The objective of the current retrospective study was to examine the survival impact of allogeneic stem cell transplant (ASCT) in a consecutive series of Mayo Clinic patients (n = 775; 68% males, median age 71 years) with CMML, overall and adjusted for baseline BLAST/BLAST-Mol risk categories. At a median follow-up of 77 months, 151 (20%) patients underwent ASCT. Overall survival (OS) was longer in the ASCT compared to the non-ASCT cohorts (median 77 vs. 28 months; p < 0.01). The significant difference in OS between the ASCT and non-ASCT cohorts was retained after adjusting for BLAST clinical risk groups: high-risk (median 50 vs. 14 months; p < 0.01), intermediate-risk (81 vs. 28 months; p < 0.01), and low-risk (111 vs. 65 months; p = 0.04), respectively. The same was mostly the case when OS comparison was adjusted for BLAST-Mol with respective p values of < 0.01, < 0.01, and 0.08, respectively. Time-dependent cox models confirmed the favorable survival impact of ASCT in the BLAST/BLAST-Mol high- and intermediate-risk groups. The current study highlights the benefit of ASCT for BLAST/BLAST-Mol high- and intermediate-risk groups in CMML and its potential to overcome the adverse impact of some high risk cytogenetic or molecular abnormalities. These observations support the early use of ASCT in CMML, ideally before BT and regardless of genetic characteristics.
Related Concept Videos
01:22Bone Marrow Sampling and Transplants
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy the...
01:21Stem Cell Therapy for Tissue Regeneration
Types of Stem Cells used in Stem Cell Therapy
The two main cell types that...