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Myelodysplasias

Mayo prognostic model for WHO-defined chronic myelomonocytic leukemia: ASXL1 and spliceosome component mutations and outcomes

Leukemia volume 27, pages 1504–1510 (2013)Cite this article

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A Corrigendum to this article was published on 09 October 2013

Abstract

We evaluated the prognostic relevance of several clinical and laboratory parameters in 226 Mayo Clinic patients with chronic myelomonocytic leukemia (CMML): 152 (67%) males and median age 71 years. At a median follow-up of 15 months, 166 (73%) deaths and 33 (14.5%) leukemic transformations were documented. In univariate analysis, significant risk factors for survival included anemia, thrombocytopenia, increased levels of white blood cells, absolute neutrophils, absolute monocyte count (AMC), absolute lymphocytes, peripheral blood and bone marrow blasts, and presence of circulating immature myeloid cells (IMCs). Spliceosome component (P=0.4) and ASXL1 mutations (P=0.37) had no impact survival. On multivariable analysis, increased AMC (>10 × 109/l, relative risk (RR) 2.5, 95% confidence interval (CI) 1.7–3.8), presence of circulating IMC (RR 2.0, 95% CI 1.4–2.7), decreased hemoglobin (<10 g/dl, RR 1.6, 99% CI 1.2–2.2) and decreased platelet count (<100 × 109/l, RR 1.4, 99% CI 1.0–1.9) remained significant. Using these four risk factors, a new prognostic model for overall (high risk, RR 4.4, 95% CI 2.9–6.7; intermediate risk, RR 2.0, 95% CI 1.4–2.9) and leukemia-free survival (high risk, RR 4.9, 95% CI 1.9–12.8; intermediate risk, RR 2.6, 95% CI 1.1–5.9) performed better than other conventional risk models and was validated in an independent cohort of 268 CMML patients.

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Acknowledgements

Current study is supported in part by grants from the ‘Myeloproliferative Disorders Foundation, Chicago, IL, USA’ and ‘The Henry J. Predolin Foundation for Research in Leukemia, Mayo Clinic, Rochester, MN, USA’.

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Authors and Affiliations

  1. Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA

    M M Patnaik, R R LaBorde, T L Lasho, C M Finke, A Al-kali, A Pardanani & A Tefferi

  2. Malignant Hematology and Immunology Program, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    E Padron, N A Ali & R S Komroji

  3. Division of Hematopathology, Department of Laboratory Medicine, Mayo Clinic, Rochester, MN, USA

    C A Hanson & J M Hodnefield

  4. Division of Cytogenetics, Department of Laboratory Medicine, Mayo Clinic, Rochester, MN, USA

    R A Knudson & R P Ketterling

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  1. M M Patnaik
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Correspondence to A Tefferi.

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Patnaik, M., Padron, E., LaBorde, R. et al. Mayo prognostic model for WHO-defined chronic myelomonocytic leukemia: ASXL1 and spliceosome component mutations and outcomes. Leukemia 27, 1504–1510 (2013). https://doi.org/10.1038/leu.2013.88

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