Journal of Clinical Oncology, Vol 6, 1417-1424, Copyright © 1988 by American Society of Clinical Oncology
Prognostic factors in adult chronic myelomonocytic leukemia: an analysis of 107 cases
P Fenaux, R Beuscart, JL Lai, JP Jouet and F Bauters
Service des Maladies du Sang, Centre Hospitalier Universitaire, Lille, France.
Adult chronic myelomonocytic leukemia (CMML), as defined by the French-
American-British (FAB) group, is associated with a variable survival,
ranging from a few weeks to several years. From 1971 to 1986, we made the
diagnosis of CMML in 107 cases, according to FAB criteria (except for
patients with 20% to 30% bone marrow [BM] blasts who were also included).
Median survival was 30 months (range 1 to 81 months) and life expectancy
did not seem to be influenced by treatment modalities other than supportive
care. Eighteen patients (17%) progressed to acute nonlymphoblastic leukemia
(ANLL). In a Cox regression model, main factors associated with short
survival were: an excess of marrow blasts (P = 10(-6], anemia (P = .17 x
10(-5], high peripheral blood (PB) monocytosis (P = .26 x 10(-5], presence
of PB blasts (P = .49 x 10(-4], and to a lesser extent hyperleukocytosis (P
= .001), presence of PB immature granulocytes, thrombopenia, and
splenomegaly. Survival (less than 1 year v greater than 1 year) could be
predicted at diagnosis in a multivariate stepwise discriminant analysis
using two parameters only (percentage of BM blasts and hemoglobin level),
with 82% accuracy. Among patients surviving greater than 1 year, initial PB
leukocyte count was higher in patients with intermediate survival (12 to 42
months) than in long survivors (greater than 42 months) and was the only
discriminating factor between these two subgroups in multivariate analysis.
Abnormal cytogenetic findings and increased lysozymuria were also poor
prognostic factors, but could not be analyzed in the multivariate models,
as they were determined in a minority of patients. Parameters associated
with subsequent progression to ANLL included younger age at diagnosis,
thrombopenia, increased BM blasts, and splenomegaly. Our study allows for
the identification of subgroups with different prognoses in CMML, on the
basis of a small number of hematologic parameters, particularly initial
percentage of BM blasts, hemoglobin level, and leukocytosis. These
subgroups probably require different therapeutic approaches.
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