Response to erythropoietic-stimulating agents in patients with chronic myelomonocytic leukemia.
BACKGROUND
The efficacy of erythropoietic-stimulating agents (ESA) in chronic myelomonocytic leukemia (CMML) is unknown. Our objective was to analyze erythroid response (ER) and overall survival (OS) in a series of 94 patients with CMML treated with ESA.


METHODS
We analyzed a series of 94 patients with CMML treated with ESA included in the Spanish and Düsseldorf-MDS registries.


RESULTS
ER was observed in 64% of patients and red blood cell (RBC) transfusion independence in 31%. The median duration of ER was 7 months (range, 0-88). CPSS and EPO level were significantly associated with ER in multivariate analysis (P = 0.003). Considering only patients with CPSS low- or intermediate-1-risk group, the absence of RBC transfusion dependence and erythropoietin (EPO) level predicted ER (P = 0.003 and P = 0.008, respectively). In multivariate analysis, only the EPO level retained its prognostic value (P = 0.029). Achievement of ER correlated with a better survival since ER evaluation (P = 0.016).


CONCLUSIONS
The CPSS and EPO levels are adequate tools to select CMML patients with symptomatic anemia who may benefit from treatment with ESA. A significant ER to ESA is expected in anemic patients with low/intermediate-1 CMML risk by the CPSS and a low endogenous serum EPO level.
Spanish Registry of MDS, Valencia, Spain.
Blanca
B
Xicoy
Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
Ulrich
U
Germing
Spanish Registry of MDS, Valencia, Spain.
María-José
MJ
Jimenez
Spanish Registry of MDS, Valencia, Spain.
Olga
O
Garcia
Spanish Registry of MDS, Valencia, Spain.
Regina
R
Garcia
Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
Jeniffer
J
Schemenau
Spanish Registry of MDS, Valencia, Spain.
Carme
C
Pedro
Spanish Registry of MDS, Valencia, Spain.
Elisa
E
Luño
Spanish Registry of MDS, Valencia, Spain.
Teresa
T
Bernal
Spanish Registry of MDS, Valencia, Spain.
Bernardo
B
González
Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
Corinna
C
Strupp
Spanish Registry of MDS, Valencia, Spain.
Maite
M
Ardanaz
Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
Andrea
A
Kuendgen
Spanish Registry of MDS, Valencia, Spain.
María-Teresa
MT
Cedena
Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
Judith
J
Neukirchen
Spanish Registry of MDS, Valencia, Spain.
Marisa
M
Calabuig
Spanish Registry of MDS, Valencia, Spain.
Salut
S
Brunet
Spanish Registry of MDS, Valencia, Spain.
Angeles
A
Medina
Spanish Registry of MDS, Valencia, Spain.
María-Luz
ML
Amigo
Spanish Registry of MDS, Valencia, Spain.
Fernando
F
Ramos
Spanish Registry of MDS, Valencia, Spain.
Marta
M
Callejas
Spanish Registry of MDS, Valencia, Spain.
María
M
Díez-Campelo
Spanish Registry of MDS, Valencia, Spain.
Alicia
A
Bailén
Spanish Registry of MDS, Valencia, Spain.
Rosa
R
Collado
Spanish Registry of MDS, Valencia, Spain.
Ana
A
Vicente
Spanish Registry of MDS, Valencia, Spain.
Montserrat
M
Arnan
Spanish Registry of MDS, Valencia, Spain.
David
D
Valcarcel
Spanish Registry of MDS, Valencia, Spain.
María Jesús
MJ
Arilla
Spanish Registry of MDS, Valencia, Spain.
Lurdes
L
Zamora
Spanish Registry of MDS, Valencia, Spain.
Luis
L
Benlloch
Spanish Registry of MDS, Valencia, Spain.
Guillermo
G
Sanz
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006397:Hematinics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D015477:Leukemia, Myelomonocytic, Chronic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome
D006397:Hematinics
chronic myelomonocytic leukemia; erythropoietic-stimulating agents; response