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Prognostic value of a new clinically-based classification system in patients with CMML undergoing allogeneic HCT: a retrospective analysis of the EBMT-CMWP

Bone Marrow Transplantation volume 57, pages 896–902 (2022)Cite this article

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Abstract

Recently a new three-group clinical classification was reported by an International Consortium to stratify CMML patients with regard to prognosis. The groups were defined as follows: (1) Myelodysplastic (MD)-CMML: WBC ≤ 10 × 109/l, circulating immature myeloid cells (IMC) = 0, no splenomegaly; (2) MD/MP (overlap)–CMML: WBC 10–20 × 109/l or WBC ≤ 10 × 109/l but IMC > 0 and/or splenomegaly; (3) Myeloproliferative (MP)-CMML: WBC > 20 × 109/l. By analysing EBMT Registry patients who underwent allo-HCT for CMML between 1997 and 2016, we aimed to determine the impact of this classification on transplantation outcome and to make a comparison with the conventional WHO classification (CMML-0/CMML-1/CMML-2). Patient grouping was based on the data registered at time of transplantation, with IMC replaced by peripheral blasts. Among 151 patients included in the analysis, 38% were classified as MD-CMML, 42% as MD/MP-CMML and 20% as MP-CMML. With a median survival of 17 months in the whole series, MD-CMML patients were distinguished as a low-risk group with higher CR rate at transplant and a longer post-transplant 2-year progression-free survival in comparison to others (44.5% vs 33.5%, respectively), whereas the WHO classification was superior in identifying high-risk patients (CMML-2) with inferior survival outcomes.

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Fig. 1: Progression-free survival by the new clinically based-CMML classification system.
Fig. 2: Overall and progression-free survival by the 2016 WHO CMML classification system.

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Authors and Affiliations

  1. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico—University of Milan, Milan, Italy

    Francesco Onida

  2. Department of Biology, Tor Vergata University, Rome, Italy

    Giulia Sbianchi & Simona Iacobelli

  3. University of Heidelberg, Heidelberg, Germany

    Aleksandar Radujkovic

  4. University Hospital Dresden, TU Dresden, Dresden, Germany

    Katja Sockel

  5. University Hospital Eppendorf, Hamburg, Germany

    Nicolaus Kröger

  6. Hospital Santa Creu i Sant Pau, Barcelona, Spain

    Jorge Sierra

  7. Hospital St. Louis, Paris, France

    Gerard Socié & Marie Robin

  8. Erasmus MC Cancer Institute, Rotterdam, The Netherlands

    Jan Cornelissen

  9. Cliniques Universitaires St. Luc, Brussels, Belgium

    Xavier Poiré

  10. Department of Hemato-Oncology—Faculty Hospital Olomouc and Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic

    Luděk Raida

  11. Gustave Roussy, Institut de Cancérologie, Val-de-Marne, Villejuif, France

    Jean Henri Bourhis

  12. University of Freiburg, Freiburg, Germany

    Jürgen Finke

  13. University Hospital, Basel, Basel, Switzerland

    Jakob Passweg

  14. Turku University Hospital, Turku, Finland

    Urpu Salmenniemi

  15. University Hospital Maastricht, Maastricht, The Netherlands

    Harry C. Schouten

  16. CHU of Liege and University of Liege, Liege, Belgium

    Yves Beguin

  17. Robert-Bosch-Krankenhaus, Stuttgart, Germany

    Sonja Martin

  18. Hospital Jean Minjoz, Besancon, France

    Eric Deconinck

  19. Hannover Medical School, Hannover, Germany

    Arnold Ganser

  20. University Medical Center, Ljubljana, Slovenia

    Samo Zver

  21. Nouvel Hopital Civil, Strasbourg, France

    Bruno Lioure

  22. Nottingham University, Nottingham, UK

    Radia Rohini

  23. EBMT Data Office Leiden, Leiden, The Netherlands

    Linda Koster

  24. Department of Haematology, Trinity College Dublin, St. James’s Hospital, Dublin 8, Ireland

    Patrick Hayden

  25. CHU de Lille, Univ Lille, Infinite, INSERM U1286, 59000, Lille, France

    Ibrahim Yakoub-Agha

Authors
  1. Francesco Onida
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Contributions

FO wrote the manuscript, designed the study, and interpreted the data. GS and SI designed the study, performed the statistical analyses, interpreted the data, and edited the manuscript. LK provided EBMT Registry Data. MR, PH, and IYA designed the study, interpreted the data, and edited the manuscript. AR, KS, NK, JS, GS, JC, XP, LR, JHB, JF, JP, US, HCS, YB, SM, ED, AG, SZ, BL, and RR reviewed the manuscript and provided clinical data. All authors approved the final version of the manuscript.

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Correspondence to Francesco Onida.

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The authors declare no competing interests.

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The current study has been approved by the scientific board of the CMWP of the EBMT.

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Onida, F., Sbianchi, G., Radujkovic, A. et al. Prognostic value of a new clinically-based classification system in patients with CMML undergoing allogeneic HCT: a retrospective analysis of the EBMT-CMWP. Bone Marrow Transplant 57, 896–902 (2022). https://doi.org/10.1038/s41409-021-01555-9

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