Therapeutic And Prognostic Significance Of Different Prognostic Scores And Gene Mutations In Chronic Myelomonocytic Leukemia

Objective: The study aims to evaluate prognosis factors and compare accuracy of different prognostic scores,and assesses clinical and prognostic significance of different prognostic scores and gene mutations in chronic myelomonocytic leukemia(CMML).Materials and methods: 45 patients were admitted to the First Affiliated Hospital of Lanzhou University from January 2008 to October 2019,all data were conducted by SPSS 24.0,the Kaplan-Meier method and log test were used to assess prognostic factors,multivariable analysis was estimated using the Cox proportional hazards regression model.MD Anderson prognostic system(MDAPS),the Global MDAPS(G-MDAPS),CMML-specific prognostic scoring system(CPSS),Groupe Fran?ais des Myelodysplasies(GFM),Mayo Molecular Model(MMM),CMML specific prognostic model(CPSS-MOL)were compared the accuracy for risk of death,rates of transformation to acute myeloid leukemia(AML)and incidence of extramedullary infiltration by ROC curves.While Pearson's correlation coefficient was implemented to find the relation with different prognostic scores and extramedullary infiltration.The karyotypes were analyzed by G banding or R banding.The gene mutations were obtained by bone marrow aspiration samples,specific gene fragments were amplified by RT-PCR technology,and the next generation sequencing technology was adopted.Results: Univariate analysis showed age,white blood cell(WBC),FrenchAmerican-British(FAB)subtypes,serum lactate dehydrogenase(LDH),WHO subtype,International Prognostic Scoring Systems(IPSS)cytogenetic risk stratification,CMML specific cytogenetic risk stratification,MD Anderson cytogenetic risk stratification,Mayo�French cytogenetic risk stratification,G-MDAPS,CPSS and CPSS-MOL were associated with overall survival(OS).Patients with chromosomal abnormalities have shorter OS and leukemia-free survival(LFS).While multivariate analysis showed WBC counts,CMML specific cytogenetic risk stratification,serum LDH were significant differences with OS.In addition,G-MDAPS was able to predict mortality better,CPSS,CPSS-MOL had more advantages in evaluating AML transformation,GFM was more accurate in evaluating incidence of extramedullary infiltration,while FAB classification had correlation with incidence of extramedullary infiltration.Gene mutations may play an important role in prognosis of CMML,eg.�dysplasia� CMML(MD-CMML)was mainly observed TET2 mutations,�proliferative� CMML(MP-CMML)was mainly observed the TET2,ASXL1,DNMT3 A,NPM1 mutations.Patients with gene mutations may lead to poor OS,and the number of gene mutations had no significant effect on prognosis,only DNMT3 A mutations were involved with poor prognosis when assessed TET2,ASXL1 and DNMT3 A mutations.Conclusion: 1.WBC,LDH,Spanish CMML cytogenetic risk stratification can significantly predict OS.G-MDAPS,CPSS and CPSS-MOL,GFM have more advantages in evaluating the morality,AML conversion,incidence of extramedullary infiltration,respectively.FAB were associated with extramedullary infiltration,this indicates MP-CMML may has higher frequency of extramedullary infiltration than MD-CMML.This study demonstrated that different prognostic scores are useful for evaluating rates of OS,mortality,AML conversion,and incidence of extramedullary infiltration in CMML.2.Patients with chromosomal abnormalities have shorter OS and leukemia-free survival(LFS).3.Patients with gene mutations may lead to poor OS,but the number of gene mutations have no effect on prognosis,and DNMT3 A mutations are associated with poor prognosis.