Inferior Survival in Therapy-Related Chronic Myelomonocytic Leukemia: A Population-Based Analysis.

IF 2.8 4区医学 Q3 HEMATOLOGY

Acta Haematologica Pub Date : 2026-09-09 DOI:10.1159/aha/abkag010

Arjun Syal, Douglas Tremblay

{"title":"Inferior Survival in Therapy-Related Chronic Myelomonocytic Leukemia: A Population-Based Analysis.","authors":"Arjun Syal, Douglas Tremblay","doi":"10.1159/aha/abkag010","DOIUrl":null,"url":null,"abstract":"Introduction: The prognostic impact of therapy-related chronic myelomonocytic leukemia (t-CMML) compared with de novo CMML (dnCMML) remains uncertain, in part due to the absence of therapy-related designations in cancer registries.Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we compared outcomes between dnCMML and t-CMML, operationally defined by antecedent chemotherapy and/or radiotherapy and diagnosis as a subsequent primary malignancy. Survival was evaluated by antecedent treatment exposure and within major antecedent malignancy groups. Additional operational definitions of t-CMML were evaluated to assess the robustness of findings.Results: Among 8,432 patients diagnosed with CMML between 2000 and 2022 after exclusion of antecedent myeloid malignancies, 594 (7.0%) met criteria for the primary definition of t-CMML. Median overall survival (OS) for the entire CMML cohort was 18 months, with shorter median OS observed for t-CMML compared with dnCMML (14 vs. 19 months). On multivariable Cox regression adjusted for age, sex, race, and era of diagnosis, t-CMML was associated with an increased risk of death (hazard ratio 1.20, 95% CI 1.09-1.32). Compared with dnCMML, inferior OS was observed among patients with recorded chemotherapy exposure but not among those treated with radiotherapy alone. Direct comparisons between chemotherapy-exposed and radiotherapy-only patients showed no significant difference in OS in the pooled adjusted analysis or within individual antecedent malignancy groups. Increasing definitional stringency was associated with stepwise worsening OS.Conclusion: Registry-defined t-CMML was associated with inferior survival compared with de novo disease. Although chemotherapy-exposed t-CMML was associated with poorer outcomes relative to dnCMML, OS did not differ significantly between chemotherapy-exposed and radiotherapy-only patients in direct pooled or malignancy-specific comparisons. Studies integrating detailed treatment histories with molecular and cytogenetic data are needed to clarify the biology and prognostic significance of t-CMML.","PeriodicalId":6981,"journal":{"name":"Acta Haematologica","volume":" ","pages":"1"},"PeriodicalIF":2.8000,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Haematologica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/aha/abkag010","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEMATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: The prognostic impact of therapy-related chronic myelomonocytic leukemia (t-CMML) compared with de novo CMML (dnCMML) remains uncertain, in part due to the absence of therapy-related designations in cancer registries.

Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we compared outcomes between dnCMML and t-CMML, operationally defined by antecedent chemotherapy and/or radiotherapy and diagnosis as a subsequent primary malignancy. Survival was evaluated by antecedent treatment exposure and within major antecedent malignancy groups. Additional operational definitions of t-CMML were evaluated to assess the robustness of findings.

Results: Among 8,432 patients diagnosed with CMML between 2000 and 2022 after exclusion of antecedent myeloid malignancies, 594 (7.0%) met criteria for the primary definition of t-CMML. Median overall survival (OS) for the entire CMML cohort was 18 months, with shorter median OS observed for t-CMML compared with dnCMML (14 vs. 19 months). On multivariable Cox regression adjusted for age, sex, race, and era of diagnosis, t-CMML was associated with an increased risk of death (hazard ratio 1.20, 95% CI 1.09-1.32). Compared with dnCMML, inferior OS was observed among patients with recorded chemotherapy exposure but not among those treated with radiotherapy alone. Direct comparisons between chemotherapy-exposed and radiotherapy-only patients showed no significant difference in OS in the pooled adjusted analysis or within individual antecedent malignancy groups. Increasing definitional stringency was associated with stepwise worsening OS.

Conclusion: Registry-defined t-CMML was associated with inferior survival compared with de novo disease. Although chemotherapy-exposed t-CMML was associated with poorer outcomes relative to dnCMML, OS did not differ significantly between chemotherapy-exposed and radiotherapy-only patients in direct pooled or malignancy-specific comparisons. Studies integrating detailed treatment histories with molecular and cytogenetic data are needed to clarify the biology and prognostic significance of t-CMML.

查看原文本刊更多论文

治疗相关慢性粒细胞白血病的低生存率：一项基于人群的分析。

背景：治疗相关性慢性粒细胞白血病（t-CMML）与新生慢性粒细胞白血病（dnCMML）的预后影响仍不确定，部分原因是癌症登记中缺乏与治疗相关的指定。方法：使用监测、流行病学和最终结果（SEER）数据库，我们比较了新生CMML （dnCMML）和治疗相关CMML （t-CMML）的结果，后者在手术上由先前的化疗和/或放疗定义，并诊断为随后的原发性恶性肿瘤。生存率通过既往治疗暴露和主要既往恶性肿瘤组进行评估。对t-CMML的其他操作定义进行评估，以评估研究结果的稳健性。结果：在2000年至2022年间，8432例排除既往髓系恶性肿瘤后诊断为CMML的患者中，594例（7.0%）符合t-CMML的主要定义标准。整个CMML队列的中位总生存期（OS）为18个月，与新生CMML相比，t-CMML的中位总生存期（OS）更短（14个月对19个月）。在校正年龄、性别、种族和诊断时代的多变量Cox回归中，t-CMML与死亡风险增加相关（风险比1.20,95% CI 1.09-1.32）。与dnCMML相比，记录化疗暴露的患者的OS较差，而单独放疗的患者则没有。化疗暴露患者和单纯放疗患者之间的直接比较显示，在合并调整分析或个别既往恶性肿瘤组中，OS无显著差异。定义严格度的增加与OS的逐步恶化相关。结论：与新发疾病相比，注册定义的t-CMML与较差的生存期相关。尽管化疗暴露的t-CMML与dnCMML相比预后较差，但在直接汇总或恶性特异性比较中，化疗暴露患者和仅放疗患者的OS没有显着差异。需要将详细的治疗史与分子和细胞遗传学数据相结合的研究来阐明t-CMML的生物学和预后意义。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Acta Haematologica 医学-血液学

CiteScore

4.90

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： ''Acta Haematologica'' is a well-established and internationally recognized clinically-oriented journal featuring balanced, wide-ranging coverage of current hematology research. A wealth of information on such problems as anemia, leukemia, lymphoma, multiple myeloma, hereditary disorders, blood coagulation, growth factors, hematopoiesis and differentiation is contained in first-rate basic and clinical papers some of which are accompanied by editorial comments by eminent experts. These are supplemented by short state-of-the-art communications, reviews and correspondence as well as occasional special issues devoted to ‘hot topics’ in hematology. These will keep the practicing hematologist well informed of the new developments in the field.