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Prognosis of patients with chronic myeloid leukemia presenting in advanced phase is defined mainly by blast count, but also by age, chromosomal aberrations and hemoglobin

M. Lauseker, K. Bachl, A. Turkina, E. Faber, W. Prejzner, U. Olsson-Strömberg, M. Baccarani, E. Lomaia, D. Zackova, G. Ossenkoppele, L. Griskevicius, G. Schubert-Fritschle, T. Sacha, S. Heibl, P. Koskenvesa, A. Bogdanovic, RE. Clark, J. Guilhot,...

. 2019 ; 94 (11) : 1236-1243. [pub] 20190914

Language English Country United States

Document type Comparative Study, Journal Article, Research Support, Non-U.S. Gov't

Persistent link   https://www.medvik.cz/link/bmc20005977

Chronic myeloid leukemia (CML) is usually diagnosed in chronic phase, yet there is a small percentage of patients that is diagnosed in accelerated phase or blast crisis. Due to this rarity, little is known about the prognosis of these patients. Our aim was to identify prognostic factors for this cohort. We identified 283 patients in the EUTOS population-based and out-study registries that were diagnosed in advanced phase. Nearly all patients were treated with tyrosine kinase inhibitors. Median survival in this heterogeneous cohort was 8.2 years. When comparing patients with more than 30% blasts to those with 20-29% blasts, the hazard ratio (HR) was 1.32 (95%-confidence interval (CI): [0.7-2.6]). Patients with 20-29% blasts had a significantly higher risk than patients with less than 20% blasts (HR: 2.24, 95%-CI: [1.2-4.0], P = .008). We found that the blast count was the most important prognostic factor; however, age, hemoglobin, basophils and other chromosomal aberrations should be considered as well. The ELTS score was able to define two groups (high risk vs non-high risk) with an HR of 3.01 (95%-CI: [1.81-5.00], P < .001). Regarding the contrasting definitions of blast crisis, our data clearly supported the 20% cut-off over the 30% cut-off in this cohort. Based on our results, we conclude that a one-phase rather than a two-phase categorization of de novo advanced phase CML patients is appropriate.

Abteilung Hämatologie Onkologie Klinik für Innere Medizin 2 Universitätsklinikum Jena Jena Germany

Chair and Department of Hematology Jagiellonian University Hospital Kraków Poland

Clinic of Hematology CCS and Faculty of Medicine University of Belgrade Belgrade Serbia

Clinical Investigation Center INSERM CIC 1402 CHU Poitiers Poitiers France

Clinical oncology Research department of oncology and hematology Almazov Medical Research Center St Petersburg Russian Federation

Department for Internal Medicine 4 Klinikum Wels Grieskirchen Wels Austria

Department of Hematology Amsterdam University Medical Center location VUmc Amsterdam The Netherlands

Department of Hematology and Oncology L and A University of Bologna Bologna Italy

Department of Hematology Medical University of Gdansk Gdansk Poland

Department of Hematology Oncology University Hospital Palacky University Olomouc Czech Republic

Department of Internal Medicine Department of Medical Science and Division of Hematology University Hospital Uppsala Sweden

Department of Internal Medicine Hematology and Oncology University Hospital Brno and Masaryk University Brno Czech Republic

Helsinki University Hospital Cancer Center and Hematology Research Unit Helsinki University Helsinki Finland

Institute for Medical Information Processing Biometry and Epidemiology Ludwig Maximilians Universität München Munich Germany

Institute of Translational Medicine University of Liverpool Liverpool UK

Munich Cancer Registry Ludwig Maximilians Universität München Munich Germany

National Research Center for Hematology Moscow Russia

Vilnius University Hospital Santaros Klinikos and Institute of Clinical Medicine Vilnius University Vilnius Lithuania

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$a Prognosis of patients with chronic myeloid leukemia presenting in advanced phase is defined mainly by blast count, but also by age, chromosomal aberrations and hemoglobin / $c M. Lauseker, K. Bachl, A. Turkina, E. Faber, W. Prejzner, U. Olsson-Strömberg, M. Baccarani, E. Lomaia, D. Zackova, G. Ossenkoppele, L. Griskevicius, G. Schubert-Fritschle, T. Sacha, S. Heibl, P. Koskenvesa, A. Bogdanovic, RE. Clark, J. Guilhot, VS. Hoffmann, J. Hasford, A. Hochhaus, M. Pfirrmann,
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$a Chronic myeloid leukemia (CML) is usually diagnosed in chronic phase, yet there is a small percentage of patients that is diagnosed in accelerated phase or blast crisis. Due to this rarity, little is known about the prognosis of these patients. Our aim was to identify prognostic factors for this cohort. We identified 283 patients in the EUTOS population-based and out-study registries that were diagnosed in advanced phase. Nearly all patients were treated with tyrosine kinase inhibitors. Median survival in this heterogeneous cohort was 8.2 years. When comparing patients with more than 30% blasts to those with 20-29% blasts, the hazard ratio (HR) was 1.32 (95%-confidence interval (CI): [0.7-2.6]). Patients with 20-29% blasts had a significantly higher risk than patients with less than 20% blasts (HR: 2.24, 95%-CI: [1.2-4.0], P = .008). We found that the blast count was the most important prognostic factor; however, age, hemoglobin, basophils and other chromosomal aberrations should be considered as well. The ELTS score was able to define two groups (high risk vs non-high risk) with an HR of 3.01 (95%-CI: [1.81-5.00], P < .001). Regarding the contrasting definitions of blast crisis, our data clearly supported the 20% cut-off over the 30% cut-off in this cohort. Based on our results, we conclude that a one-phase rather than a two-phase categorization of de novo advanced phase CML patients is appropriate.
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