Prognostic factors and survival in chronic myelomonocytic leukaemia (CMML)

Abstract

Summary Ninety-seven cases of chronic myelomonocytic leukaemia (CMML) were examined retrospectively for survival and possible prognostic factors including age, total white cell count, peripheral blood and bone marrow monocyte counts, % double esterase (DE) positive cells in bone marrow and serum lysozyme. Age, absolute monocyte counts and serum lysozyme proved to be significant independent prognostic indicators but Cox model analyses showed serum lysozyme to be the most important factor whether taken as a continuous or discrete (two groups) variable. Twelve cases of second malignancy were found, including 2 cases of multiple myeloma, but this was not significantly greater than expected when compared with an age and sex matched group.

Prognostic factors and scoring systems in chronic myelomonocytic leukemia: a retrospective analysis of 213 patients

“…Compared with survival times calculated for all 213 patients in the study, median survival for this subset of patients was longer (16 months; 95% CI, 10.6-19.0), and it was closer to those cited in previously reported CMML series. 12,13,15,17,20,21,24,25,30 The results obtained by the analysis of this restricted CMML subpopulation are comparable to those obtained in the analysis of the whole CMML series, with one exception: Bone marrow blast percentage was not significant in a multivariate model that contained hemoglobin level below 120 g/L (12 g/dL), absolute lymphocyte count above 2.5 ϫ 10 9 /L, and presence of peripheral blood IMCs (data not shown).…”

“…Most such studies have been carried out within overall populations of MDS patients; the largest number of patients with CMML included in a single study was 125. 12 At least 19 studies [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] that included more than 30 patients with CMML each sought to assess the prognostic value of laboratory and clinical variables and to delineate prognostic factors. However, the selection of patients for these studies was undoubtedly influenced by diagnostic criteria.…”

A Forgotten Cause of Kidney Injury in Chronic Myelomonocytic Leukemia

“…Other causes of decreased kidney function need to be excluded, including prerenal conditions (ie, volume depletion, heart failure, and medications affecting the renin-angiotensin-aldosterone system) and postrenal causes (ie, obstruction of ureters from lymphadenopathy; Box 1). CMML, a hybrid disorder characterized by overlap of myelodysplastic and myeloproliferative disorders,3 affects predominantly elderly patients 4. The disorder affects kidneys through infiltration of monocytes in glomeruli,1,5 amyloid deposition, 6 production of tumor necrosis factor α,7 and, rarely, increased production and excretion of lysozyme.…”

Two Cases of Acute Myeloid Leukemia Evolving into a Chronic Myelomonocytic Leukemia-like State after Induction Therapy.

“…The present two cases fell into this rare category. CMMoL is reported to occur frequently in the elderly (7,8,(10)(11)(12)(13)(14)(15)(16)(17) and its myeloproliferative features have been well recognized (15,18,19). Both of the present patients were elderly and presented with marked leuko cytosis, monocytosis, and organomegaly.…”

“…Acute transformation from CMMoL is reported to occur in 5-37% of patients (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17), and the most common type of AML involved is M4 (FAB classification) (Table 2) (7,8,14,15,17). Some patients with AML preceded by an apparent CMMoL-like state sometimes return to the CMMoL-like state after successful chemotherapy.…”