Prognostic Factors in Chronic Myelomonocytic Leukemia: A Retrospective Analysis of 41 Patients

Purpose To investigate clinical characteristic and prognostic factors for chronic myelomonocytic leukemia (CMML).

Methods Retrospective cohort study was used in the study. Information for CMML patients was collected, including symptoms, CBC, results of bone marrow aspire and pathology, cytogenetic. All patients were followed up regularly. Analysis of survival and prognostic factors was performed by Kaplan-Merier cure, log rank test and Cox regression model.

Results Forty-one cases were diagnosed as CMML, including 27 male and 14 female patients. Median WBC was 13.7× 10⁹/L. Five patients had leukocytopenia(1.92- 3.46×10⁹/L). Median monocyte count in the peripheral blood was 2.13×10⁹/L, but lower monocyte count (<1×10⁹/L) occurred in 8 patients. All patients presented with bone marrow dysplasia, and most showed hyperplasia, except 3 cases. Abnormal chromosome was detected in 34% cases. Median survival time was 20 months, and there were no difference of survival duration between CMML-1 and CMML-2. Univariate analysis showed that age (> 60 yrs), neutrophil count (<2.0′10⁹/L), lymphocyte count (<1.0′10⁹/L), mature monocyte count (³5′10⁹/L) and anemia (Hb< 60g/L) were associated with poor prognosis for CMML. There was no statistical significance in LDH, gender, abnormal chromosome for survival time. Only lymphocyte count and neutrophil count in peripheral blood were independent prognostic factor for CMML after Multivariate analysis.

Conclusion CMML mainly occur in elderly patients. Although most patients have leukocytosis and monocytosis at diagnosis, few case shows leucopenia and monocytopenia. Median survival time for CMML is 20 months. Age, neutrophil, lymphocyte and monocyte count, severe anemia are related to CMML prognosis. Neutropenia and lymphopenia in peripheral blood are independent prognostic factor for CMML.