title: Patients With Therapy-Related CMML Have Shorter Median Overall Survival Than Those With De Novo CMML: Mayo Clinic Long-Term Follow-Up Experience.
abstract: BACKGROUND
  Chronic myelomonocytic leukemia (CMML) is a malignant hematologic neoplasm characterized by peripheral blood monocytosis and bone marrow dysplasia. The World Health Organization classified therapy-related (t-) myeloid neoplasm (MN) as another category. It is known that t-MNs tend to have a worse prognosis than de novo (dn-) MN (dn-MN).
  
  
  METHODS
  Previous exposure to chemotherapy (CT), radiotherapy (RT), or both were defined as t-CMML and lack of both as dn-CMML.
  
  
  RESULTS
  Of 265 CMML patients, 30 (11%) had t-CMML. Seventeen (57%) patients had previous exposure to CT, 6 (20%) to RT, and 7 (23%) to CT and RT. Leukemic transformation (LT) was seen in 5 (17%). In comparison, only lower platelet count was found to be statistically significant compared with dn-CMML. Median overall survival (OS) was 20 months in the dn-CMML group versus 11 months in the t-CMML group (P = .02). Median OS was 9 months in the CT group versus 4.4 months in the RT group versus 13 months in the CT and RT group (P = .7).
  
  
  CONCLUSIONS
  t-CMML comprises a small portion of all CMML cases (11%). Median OS in the dn-CMML group was longer than in the t-CMML group but LT seemed to be similar in terms of incidence and time to occurrence. Additional studies are needed to confirm our results.
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN.
authors.forename: Salih
authors.initials: S
authors.lastname: Subari
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN.
authors.forename: Mrinal
authors.initials: M
authors.lastname: Patnaik
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN.
authors.forename: Dima
authors.initials: D
authors.lastname: Alfakara
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN.
authors.forename: Naseema
authors.initials: N
authors.lastname: Gangat
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN.
authors.forename: Michelle
authors.initials: M
authors.lastname: Elliott
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN.
authors.forename: William
authors.initials: W
authors.lastname: Hogan
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN.
authors.forename: Mark
authors.initials: M
authors.lastname: Litzow
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN. Electronic address: alkali.aref@mayo.edu.
authors.forename: Aref
authors.initials: A
authors.lastname: Al-Kali
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015477:Leukemia, Myelomonocytic, Chronic / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
keywords: Chronic myelomonocytic leukemia; Hypomethylation; Leukemic transformation; Survival; Treatment-related