The clinical presentation of chronic myeloid leukemia (CML) at diagnosis differs in children compared to adults. At younger age, anemia appears to be frequent at diagnosis, but its prevalence and its impact on prognosis are not well known. In the International Registry of Childhood CML, we selected children and adolescents in chronic phase at diagnosis of CML and treated upfront with imatinib. We examined their hemoglobin level at diagnosis according to the WHO grades to assess the prevalence of anemia and its impact on response to tyrosine kinase inhibitors (TKIs). Data on 430 patients were included. Anemia at diagnosis was observed in 350 patients (81%), with a mean hemoglobin level of 96.4 g/l (SD 23.6). Among them, 182 patients (52%) presented with moderate anemia and 110 (31%) with severe anemia while 58 (17%) had mild anemia. Compared with mild and no anemia, moderate and severe forms were significantly associated with younger age at diagnosis, asthenia, splenomegaly, and increased leukocyte and basophil counts. Delays in achieving major and deep molecular responses were significantly increased for patients with moderate and severe anemia, and also failure of imatinib treatment was more frequent in these two sub-cohorts. However, hemoglobin level was not significantly associated with survival. Anemia at diagnosis of pediatric CML was frequent and may be considered as a prognostic factor.

Department of Biostatistics and Clinical Research University Hospital of Caen Normandy Caen France

Department of Pediatric Blood and Marrow Transplantation Prinses Maxima Center Utrecht The Netherlands

Department of Pediatric Hematology Oncology and Transplantation Wroclaw Medical University Wroclaw Poland

Department of Pediatric Hematology Oncology Immunology and Medical Genetic Split Croatia

Department of Pediatric Hematology Oncology University Hospital Motole Charles University Prague Czech Republic

Department of Pediatric Hematology Uludağ University Hospital Görükle Bursa Turkey

Department of Pediatric Oncology and Hematology University Hospital of Caen Avenue de La Côte de Nacre 14000 Caen France

Department of Pediatric Oncology of University Children's Hospital Bratislava Slovakia

Department of Pediatrics Ghent University Hospital Ghent Belgium

Department of Pediatrics Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong China

Department of Pediatrics Rigshospitalet University Hospital Copenhagen Denmark

Department of Pediatrics Saint George Hospital University Medical Centre Beirut Lebanon

Inserm University Hospital CIC 1402 Poitiers France

Pediatric Hemato Oncology Medical Faculty Technical University of Dresden Dresden Germany

Pediatric Intensive Care Unit CHU de Caen 14000 Caen France

St Anna Children's Cancer Research Institute Vienna Austria

St Anna Children's Hospital Medical University of Vienna Department of Pediatrics and Adolescent Medicine Vienna Austria

Université Caen Normandie Medical School 14000 Caen France

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