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Wien Klin Wochenschr. 2018 Feb;130(3-4):115-125. doi: 10.1007/s00508-018-1315-2. Epub 2018 Jan 30.

Establishment and validation of a novel risk model for estimating time to first treatment in 120 patients with chronic myelomonocytic leukaemia.

Author information

1
Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Disease, Rheumatology, Oncologic Center, Laboratory of Immunological and Molecular Cancer Research, Paracelsus Medical University Salzburg, Muellner Hauptstraße 48, 5020, Salzburg, Austria.
2
Cancer Cluster Salzburg, Salzburg, Austria.
3
Institute of Pathology, Paracelsus Medical University, Salzburg, Austria.
4
5th Department of Medicine, Hospital Hietzing, Vienna, Austria.
5
Clinical Division of Internal Medicine 3‑Hematology and Oncology, Kepler University Hospital, Linz, Austria.
6
Division of Haematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
7
Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria.
8
Department for Haematology and Oncology, LKH Hochsteiermark, Leoben, Austria.
9
Department of Internal Medicine V, Innsbruck Medical University, Innsbruck, Austria.
10
Department of Internal Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria.
11
Department of Internal Medicine, Landeskrankenhaus Feldkirch, Feldkirch, Austria.
12
3rd Medical Department for Haematology and Oncology, Hanusch Hospital, Vienna, Austria.
13
Department of Haematology and Oncology, Elisabethinen Hospital, Linz, Austria.
14
Department of Internal Medicine 2, Donauspital-SMZO, Vienna, Austria.
15
Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Disease, Rheumatology, Oncologic Center, Laboratory of Immunological and Molecular Cancer Research, Paracelsus Medical University Salzburg, Muellner Hauptstraße 48, 5020, Salzburg, Austria. l.pleyer@salk.at.
16
Cancer Cluster Salzburg, Salzburg, Austria. l.pleyer@salk.at.

Abstract

Chronic myelomonocytic leukaemia is a rare disease and data on the treatment are often extrapolated from myelodysplastic syndrome studies. Although several scores exist for the prognosis of overall survival in chronic myelomonocytic leukaemia, so far there is no designated score for the prediction of the time to first treatment. We tested clinical parameters and cytogenetic information for their ability to predict the time to first treatment in our single center cohort of 55 unselected consecutive chronic myelomonocytic leukaemia patients. In multivariate analysis we identified elevated lactate dehydrogenase (≥223 U/l), higher bone marrow blast percentage (≥7.5%) and thrombocytopenia (<55 G/l) at initial diagnosis as the most relevant parameters for the time to first treatment. Using these three parameters we developed a risk score that efficiently estimates the time to treatment initiation with azacitidine or hydroxyurea (p < 0.001; log-rank). In the high-risk group (≥2 risk factors) 85% of patients required treatment within 1 year, whereas this was the case in 48% in the intermediate-risk (1 risk factor) and in 0% in the low-risk group (0 risk factors). Our risk model was validated in an external test cohort of 65 patients and may serve as a simplified and easily applicable tool for identifying patients who may not require early treatment initiation.

KEYWORDS:

Austrian Registry on Hypomethylating Agents; Azacitidine; CMML; Hydroxyurea; Prognostic factors

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