Blast transformation in chronic myelomonocytic leukemia: Risk factors, genetic features, survival, and treatment outcome. Issue 5 (1st April 2015)

• Record Type: Journal Article
• Authors: Patnaik, Mrinal M.; Wassie, Emnet A.; Lasho, Terra L.; Hanson, Curtis A.; Ketterling, Rhett; Tefferi, Ayalew
• Is Part Of: American journal of hematology. Volume 90:Issue 5(2015:May)
• Page Start: 411
• Page End: 416
• Publication Date: 2015-04-01
• Subjects: Hematology -- Periodicals; 616.15
• DOI: 10.1002/ajh.23962
• Languages: English
• ISSNs: 0361-8609

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <p>Among 274 patients with chronic myelomonocytic leukemia (CMML) and followed for a median of 17.1 months, blast transformation (BT) occurred in 36 (13%). On multivariable analysis, risk factors for BT were presence of circulating blasts (HR 5.7; 95% CI 2.8–11.9) and female gender (HR 2.6; 95% CI 1.3–5.1); the results remained unchanged when analysis was restricted to CMML‐1. <italic>ASXL1/SRSF2/SF3B1/U2AF1/SETBP1</italic> mutational frequencies were not significantly different between time of CMML diagnosis and BT. Median survival post‐BT was 4.7 months (5‐year survival 6%) and better with allogeneic stem cell transplant (SCT) (14.3 months vs. 4.3 months for chemotherapy vs. 0.9 months for supportive care; <italic>P</italic> = 0.03). Neither karyotype nor mutational status was independently associated with risk of BT or post‐BT survival. We conclude that female patients with CMML and those with circulating blasts are at a higher risk of BT. Post‐BT survival is dismal and our observations suggest consideration of allogeneic SCT prior to BT.Am. J. Hematol. 90:411–416, 2015. © 2015 Wiley Periodicals, Inc.</p> </abstract>