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Blood, 1 February 2002, Vol. 99, No. 3, pp. 840-849
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Prognostic factors and scoring systems in chronic myelomonocytic
leukemia: a retrospective analysis of 213 patients
Francesco Onida,
Hagop M. Kantarjian,
Terry L. Smith,
Greg Ball,
Michael J. Keating,
Elihu H. Estey,
Armand B. Glassman,
Maher Albitar,
Monica I. Kwari, and
Miloslav Beran
From the Department of Leukemia, Department of
Biostatistics, and Department of Hematopathology, The University of
Texas M. D. Anderson Cancer Center, Houston.
Chronic myelomonocytic leukemia (CMML) is a hematologic
malignancy characterized by wide heterogeneity of clinical presentation and course. CMML shares myelodysplastic characteristics with features of myeloproliferative disorders. No treatment has proven effective in
modifying the natural course of the disease. To improve the prognostic
assessment of clinical outcome, the associations of patient and disease
characteristics with survival times of 213 patients with CMML was
investigated retrospectively. Median survival was 12 months.
Univariate analysis identified low hemoglobin level; low platelet
count; high white blood cell, monocyte, and lymphocyte counts; presence
of circulating immature myeloid cells, high percentage of marrow
blasts, low percentage of marrow erythroid cells, abnormal cytogenetics, and high levels of serum lactate dehydrogenase and  2-microglobulin as characteristics associated with
shorter survival. Hemoglobin level below 120 g/L (12 g/dL), presence of
circulating immature myeloid cells, absolute lymphocyte count above
2.5 × 109/L, and marrow blasts 10% or more were
independently associated with shorter survival by multivariate analysis
and were used to generate a prognostic score. The model identified 4 subgroups of patients with median survival of 24, 15, 8, and 5 months
for low, intermediate-1, intermediate-2, and high risk, respectively. Researchers could not confer objective evidence suggesting that arbitrary divisions of CMML by white blood cell counts into
"dysplastic" and "proliferative" categories reflect clinical
entities differing in the risk of acute leukemia development, although
a trend of shorter survival in patients with leukocytosis was
observed. The prognostic model was compared with 6 previously
published scoring systems for myelodysplastic syndrome/CMML. The
reported results should provide an improved assessment of prognosis in CMML.
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