Prognostic factors and scoring systems in chronic myelomonocytic leukemia: a retrospective analysis of 213 patients
Prognostic factors and scoring systems in chronic myelomonocytic leukemia: a retrospective analysis of 213 patients
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DOI：
10.1182/blood.v99.3.840
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发表时间：
2002-02-01
期刊：
影响因子：
20.3
通讯作者：
Beran, M
中科院分区：
文献类型：
--
作者：
Onida, F;Kantarjian, HM;Beran, M
慢性粒单核细胞白血病（CMML）是一种血液系统恶性肿瘤，其临床表现和病程具有广泛的异质性。CMML具有骨髓增生异常的特征。没有一种治疗方法能有效地改变这种疾病的自然病程.为提高临床预后评估的准确性，对213例CMML患者的患者和疾病特征与生存时间的关系进行了回顾性研究。中位生存期为12个月。单变量分析确定低血红蛋白水平;低血小板计数;高白色血细胞、单核细胞和淋巴细胞计数;存在循环未成熟髓系细胞、高骨髓原始细胞百分比、低骨髓红系细胞百分比、异常细胞遗传学和高血清乳酸脱氢酶和β 2-微球蛋白水平是与生存期较短相关的特征。通过多变量分析，血红蛋白水平低于120 g/L（12 g/dL）、存在循环未成熟髓系细胞、淋巴细胞绝对计数高于2.5 x 10（9）/L、骨髓原始细胞10%或更多与生存期较短独立相关，并用于生成预后评分。该模型确定了4个亚组的患者，中位生存期分别为24个月、15个月、8个月和5个月，分别为低风险、中风险-1风险、中风险-2风险和高风险。研究人员不能提供客观证据表明，根据白色血细胞计数将CMML任意划分为“发育不良”和“增殖性”类别反映了急性白血病发展风险的临床差异，尽管观察到白细胞增多患者的生存期较短的趋势。将该预后模型与6个先前发表的骨髓增生异常综合征/CMML评分系统进行比较。报告的结果应提供对CMML预后的更好评估。(C)2002年，美国血液学会。
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 beta(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 x 10(9)/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 entitles 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. (C) 2002 by The American Society of Hematology.