Role of allogeneic transplantation in chronic myelomonocytic leukemia: an international collaborative analysis

Robin, M.; Wreede, L.C. de; Padron, E.; Bakunina, K.; Fenaux, P.; Koster, L.; ... ; Itzykson, R. (2022)

Article / Letter to editor

To determine the survival benefit of allogeneic hematopoietic cell transplantation (allo-HCT) in chronic myelomonocytic leukemias (CMML), we assembled a retrospective cohort of CMML patients 18-70 years old diagnosed between 2000 and 2014 from an international CMML dataset (n 5 730) and the EBMT registry (n 5 384). The prognostic impact of allo-HCT was analyzed through univariable and multivariable time-dependent models and with a multistate model, accounting for age, sex, CMML prognostic scoring system (low or intermediate-1 grouped as lower-risk, intermediate-2 or high as higher-risk) at diagnosis, and AML transformation. In univariable analysis, lower-risk CMMLs had a 5-year overall survival (OS) of 20% with allo-HCT vs 42% without allo-HCT (P <.001). In higher-risk patients, 5-year OS was 27% with allo-HCT vs 15% without allo-HCT (P 5.13). With multistate models, performing allo-HCT before AML transformation reduced OS in patients with lower-risk CMML, and a survival benefit was predicted for men with higher-risk CMML. In a multivariable analysis of lower-risk patients, performing allo-HCT before transformation to AML significantly increased the risk of death within 2 years of transplantation (hazard ratio [HR], 3.19; P <.001), with no significant change in long-term survival beyond this time point (HR, 0.98; P 5.92). In higherrisk patients, allo-HCT significantly increased the risk of death in the first 2 years after transplant (HR 1.46; P 5.01) but not beyond (HR, 0.60; P 5.09). Performing allo-HCT before AML transformation decreases life expectancy in lower-risk patients but may be considered in higher-risk patients.

• All authors: Robin, M.; Wreede, L.C. de; Padron, E.; Bakunina, K.; Fenaux, P.; Koster, L.; Nazha, A.; Beelen, D.W.; Rampal, R.K.; Sockel, K.; Komrokji, R.S.; Gagelmann, N.; Eikema, D.J.; Radujkovic, A.; Finke, J.; Potter, V.; Killick, S.B.; Legrand, F.; Solary, E.; Broom, A.; Garcia-Manero, G.; Rizzoli, V.; Hayden, P.; Patnaik, M.M.; Onida, F.; Yakoub-Agha, I.; Itzykson, R.
• Date: 2022-09-22
• Journal: Blood
• Volume: 140
• Issue: 12
• Pages: 1408 - 1418
• DOI: doi:10.1182/blood.2021015173
• Link: https://ashpublications.org/blood/article/140/12/1408/485477/Role-of-all...