Clinical Features And Prognosis Analysis Of 98 Cases Of Chronic Myelomonocytic Leukemia

Objective:Chronic myelomonocytic leukemia(CMML)is a clonal hematopoietic stem cell disorder with myelodysplastic and myeloproliferative overlap features.Through a retrospective study of the clinical data and survival of 98 patients with CMML,we can increase our understanding of the disease.Methods: 98 newly diagnosed and newly diagnosed CMML patients at Shengjing Hospital affiliated with China Medical University from January 1,2015 to December 1,2022 were collected,all of whom met FAB and WHO standards for 2022.Their general clinical characteristics and gene mutations were summarized,and their survival status was followed up by medical records or telephone calls.Kaplan Meier method was used for univariate survival analysis,and Cox regression curve model was used for multivariate analysis,Spearman Rank correlation coefficient was used for correlation analysis.Explore the unfavorable prognostic factors of CMML patients and analyze the correlation between common mutated genes and related clinical features.Result:(1)The median onset age of 98 patients with chronic myelomonocytic leukemia was 64 years old,including 64 males(65.3%),34 females(34.7%),and 61 patients over 60 years old(62.2%).The median survival period was 22.7 months.According to the FAB collaborative classification criteria,there were 40 cases(40.8%)of MD-CMML and 58cases(59.2%)of MP-CMML.According to the WHO(2022)classification criteria,there were 58 cases(59.2%)of CMML-1 and 40 cases(40.8%)of CMML-2.(2)According to Anderson’s prognosis score,the risk stratification was conducted,and the median survival periods for low risk,medium risk-1,medium risk-2,and high risk were 26.8,23.1,20.6,and 13.1 months,respectively,with statistically significant differences(P=0.029).According to the CMML specific prognostic scoring system,the risk stratification was performed,and the median survival periods for low-risk,medium risk-1,medium risk-2,and high risk were 25.8,25.7,11.1,and 7.5 months,respectively,with statistically significant differences(P=0.034).According to the CPSS mol scoring system for risk stratification,the median survival periods for medium risk-1,medium risk-2,and high risk were 23.3,22.8,and 13.8 months,respectively,with differences but no statistical significance(P=0.156).According to the MMM scoring system for risk stratification,the median survival periods for medium risk-1,medium risk-2,and high risk were 11.5,25.1,and 22.7 months,respectively,with differences but no statistical significance(P=0.502).(3)Single factor survival analysis results suggest that WBC ≥ 13×10^9/L、ANC≥8×10^9/L、AMC>10×10 ^ 9/L,HB<80g/L,transfusion dependent,PLT<100×10 ^ 9/L,LDH>280U/L,bone marrow Archaeocyte>10%,CMML-2,MP-CMML,ASXL1 mutant,KRAS mutant are associated with poor overall survival(OS).Multivariate survival analysis suggests that hemoglobin levels are an independent prognostic risk factor for OS in CMML patients.(4)Some gene mutations have significant correlation with the clinical characteristics of CMML patients.ASXL1(P=0.004)and TET2(P=0.033)mutations are common in elderly patients.Conclusion: Chronic myelomonocytic leukemia is common in elderly men and has a short overall survival period.Single factor survival analysis suggested WBC ≥ 13 ×10^9/L、ANC≥8 ×10^9/L、AMC>10 ×10 ^ 9/L,HB < 80g/L,blood transfusion dependence,PLT <100×10 ^ 9/L,LDH>280U/L,bone marrow primordial cells>10%,CMML-2,MP-CMML,ASXL1 mutation,KRAS mutation are associated with poor OS.Multivariate survival analysis suggested that Hemoglobin was a poor prognostic factor for OS in CMML patients.HAM treatment cannot effectively prolong the total survival period of patients.