Cytogenetic risk stratification of 417 patients with chronic myelomonocytic leukemia from a single institution
Cytogenetic risk stratification of 417 patients with chronic myelomonocytic leukemia from a single institution
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DOI：
10.1002/ajh.23751
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发表时间：
2014-08-01
影响因子：
12.8
通讯作者：
Wang, Sa A.
中科院分区：
文献类型：
--
作者：
Tang, Guilin;Zhang, Liping;Wang, Sa A.
大约30%的慢性髓细胞白血病（CMML）患者有核型异常，这种低频率使得使用细胞遗传学数据预测CMML患者的预后具有挑战性。最近，一个西班牙研究小组提出了CMML患者的三层细胞遗传学风险分层系统。在这里，我们评估了来自我们机构的417名CMML患者的细胞遗传学异常对总生存期（OS）和无白血病生存期（LFS）的预后影响。总体而言，西班牙细胞遗传学风险有效地将患者分层为不同的风险组，低危组的中位OS为33个月，中危组为24个月，高危组为14个月。然而，在建议的高风险组中，观察到OS的显着差异。分离性8三体患者的中位OS为22个月，与中危组相似（P = 0.132），但明显优于高危组其他患者（P = 0.018）。此外，有3个以上染色体异常的患者的OS明显短于有3个异常的患者（8个月vs 15个月，P = 0.004），提示可能存在单独的风险类别。如果我们简单地将8三体转移到中间风险类别，改良的细胞遗传学分组将提供更好的OS和LFS分离；其预后影响与其他风险参数无关。我们的研究结果强烈支持将细胞遗传学信息纳入CMML的风险模型。(C) 2014 Wiley期刊公司
Approximately 30% of patients with chronic myelomonocytic leukemia (CMML) have karyotypic abnormalities and this low frequency has made using cytogenetic data for the prognostication of CMML patients challenging. Recently, a three-tiered cytogenetic risk stratification system for CMML patients has been proposed by a Spanish study group. Here we assessed the prognostic impact of cytogenetic abnormalities on overall survival (OS) and leukemia-free survival (LFS) in 417 CMML patients from our institution. Overall, the Spanish cytogenetic risk effectively stratified patients into different risk groups, with a median OS of 33 months in the low-, 24 months in intermediate-and 14 months in the high-risk groups. Within the proposed high risk group, however, marked differences in OS were observed. Patients with isolated trisomy 8 showed a median OS of 22 months, similar to the intermediate-risk group (P = 0.132), but significantly better than other patients in the high-risk group (P = 0.018). Furthermore, patients with more than three chromosomal abnormalities showed a significantly shorter OS compared with patients with three abnormalities (8 vs. 15 months, P = 0.004), suggesting possible a separate risk category. If we simply moved trisomy 8 to the intermediate risk category, the modified cytogenetic grouping would provide a better separation of OS and LFS; and its prognostic impact was independent of other risk parameters. Our study results strongly advocate for the incorporation of cytogenetic information in the risk model for CMML. (C) 2014 Wiley Periodicals, Inc.