Cytogenetic risk stratification in chronic myelomonocytic leukemia.
BACKGROUND
The prognostic value of cytogenetic findings in chronic myelomonocytic leukemia is unclear. Our purpose was to evaluate the independent prognostic impact of cytogenetic abnormalities in a large series of patients with chronic myelomonocytic leukemia included in the database of the Spanish Registry of Myelodysplastic Syndromes.


METHODS
We studied 414 patients with chronic myelomonocytic leukemia according to WHO criteria and with a successful conventional cytogenetic analysis at diagnosis. Different patient and disease characteristics were examined by univariate and multivariate methods to establish their relationship with overall survival and evolution to acute myeloid leukemia.


RESULTS
Patients with abnormal karyotype (110 patients, 27%) had poorer overall survival (P=0.001) and higher risk of acute myeloid leukemia evolution (P=0.010). Based on outcome analysis, three cytogenetic risk categories were identified: low risk (normal karyotype or loss of Y chromosome as a single anomaly), high risk (presence of trisomy 8 or abnormalities of chromosome 7, or complex karyotype), and intermediate risk (all other abnormalities). Overall survival at five years for patients in the low, intermediate, and high risk cytogenetic categories was 35%, 26%, and 4%, respectively (P<0.001). Multivariate analysis confirmed that this new CMML-specific cytogenetic risk stratification was an independent prognostic variable for overall survival (P=0.001). Additionally, patients belonging to the high-risk cytogenetic category also had a higher risk of acute myeloid leukemia evolution on univariate (P=0.001) but not multivariate analysis.


CONCLUSIONS
Cytogenetic findings have a strong prognostic impact in patients with chronic myelomonocytic leukemia.
Hospital Universitario La Fe, Avenida Campanar, 21. 46009 Valencia, Spain.
Esperanza
E
Such
José
J
Cervera
Dolors
D
Costa
Francesc
F
Solé
Teresa
T
Vallespí
Elisa
E
Luño
Rosa
R
Collado
María J
MJ
Calasanz
Jesús M
JM
Hernández-Rivas
Juan C
JC
Cigudosa
Benet
B
Nomdedeu
Mar
M
Mallo
Felix
F
Carbonell
Javier
J
Bueno
María T
MT
Ardanaz
Fernando
F
Ramos
Mar
M
Tormo
Reyes
R
Sancho-Tello
Consuelo
C
del Cañizo
Valle
V
Gómez
Victor
V
Marco
Blanca
B
Xicoy
Santiago
S
Bonanad
Carmen
C
Pedro
Teresa
T
Bernal
Guillermo F
GF
Sanz
D000368:Aged; D002869:Chromosome Aberrations / Q000145:classification; D002897:Chromosomes, Human, Pair 7 / Q000235:genetics; D002898:Chromosomes, Human, Pair 8; D005260:Female; D006801:Humans; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D015477:Leukemia, Myelomonocytic, Chronic / Q000150:complications / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D013030:Spain; D015996:Survival Rate; D014314:Trisomy / Q000473:pathology