From the Guidelines
The overall survival rate for patients with Chronic Myelomonocytic Leukemia (CMML) is approximately 30-40% at 5 years after allogeneic hematopoietic cell transplantation (allo-HCT) 1. This survival rate is influenced by various factors, including the patient's age, disease risk, and response to treatment.
- Key factors affecting survival include:
- Disease risk, with higher-risk patients having poorer outcomes
- Age, with older patients having poorer outcomes
- Response to treatment, with patients achieving complete remission having better outcomes
- Treatment approaches, such as hypomethylating agents like azacitidine or decitabine, may improve survival in some patients, particularly those with higher-risk disease 1.
- Allogeneic hematopoietic stem cell transplantation remains the only potentially curative option, but it is limited to younger, fit patients with suitable donors 1. The decision to proceed with allo-HCT should be made on a case-by-case basis, taking into account the patient's individual risk factors and overall health status 1.
- Regular monitoring of blood counts, symptoms, and disease progression is essential for managing CMML and optimizing survival outcomes.
- The European Society for Blood and Marrow Transplantation (EBMT) Practice Harmonization and Guidelines (PH&G) Committee recommends upfront transplantation without prior disease-modifying treatment to maximize chances of reaching allo-HCT whenever possible, irrespective of bone marrow blast counts 1.
From the Research
Survival Rate of Patients with Chronic Myelomonocytic Leukemia (CMML)
- The median overall survival (OS) for patients with CMML treated with hypomethylating agents was 24 months (95%CI: 20-28) 2.
- A study found that the adjusted median overall survival for patients treated with hydroxyurea versus hypomethylating agents was 15·6 months (95% CI 13·1-17·3) versus 20·7 months (17·9-23·4) 3.
- Patients with myeloproliferative CMML had a median overall survival of 12·6 months (10·7-15·0) versus 17·6 months (14·8-21·5) for patients treated with hydroxyurea versus hypomethylating agents 3.
- Chemotherapy, including hypomethylating agents, prolonged overall survival of CMML patients, especially in patients with blast cell ≥10% in bone marrow or WHO CMML-2, compared to supportive therapy 4.
- The median survival was 32 months, 18.5 months, and 10 months in the low, intermediate, and high-risk groups, respectively, based on the Mayo prognostic model 5.
- After a median follow-up of 2.5 years, survival ranged from not reached in the low-risk group to 14.4 months in the high-risk group, based on the Groupe Francophone des (GFM) score 5.
- The median OS from onset of decitabine was 7.3 months for patients with high-risk MDS and CMML who received decitabine after azacitidine failure 6.
Prognostic Factors
- Age < 70 years, higher levels of hemoglobin, absence of blast in peripheral blood, and lower CPSS cytogenetic risk predicted better OS 2.
- Supportive therapy and intermediate-2/high in CPSS were independent risk factors for OS after propensity score matching (PSM) 4.
- The presence of certain gene mutations, such as ASXL1MT, TET2MT, and SRSF2 MT, may influence the prognosis of CMML patients 4.