Abstract
Backgrounds: Chronic myelomonocytic leukaemia (CMML) is a relatively rare neoplastic disorder with features of both myelodysplastic and myeloproliferative diseases. The aim of this work is to provide information from an unselected group of patients treated in several haematological centres.
Patients and Methods: This retrospective analysis included the treatment results obtained in a cohort of 55 patients with CMML treated at 4 Czech haematological centres from 2000 to 2015. Results: 16 patients (29%) are still alive with median overall survival (OS) of 21 months (to the date 1st of June 2016).
Patients undergoing allogeneic stem cell transplantation (alloSCT) demonstrated the best survival - 7 out of 14 allografted patients remain alive. 5-year OS in this unselected patient population was approx. 14 %. CPSS appears to be a suitable OS predictor (low risk vs. lower intermediate risk vs. higher intermediate risk, p = 0.04).
In multivariate analysis combining patient age and comorbidities with CPSS, we did not see any further impact of these additional parameters on the OS. Disease progression was the most common cause of death (31%) followed by infections (24%).
We evaluated the effects of BSC (best supportive care), hypomethylating agents (HMA) and alloSCT on OS. Transplanted patients appeared at least initially to benefit from this treatment (~2 years).
It appears that treatment with 5-azacytidine (AZA) shows better results than BSC. However, these conclusions relate to a small patient cohort and also the subgroups are significantly heterogeneous with respect to other the predictors.
The log-rank test did not confirm the statistical significance of different treatment approaches (p = 0.27). Conclusion: Treatment results in CMML remain unsatisfactory.
Introduction of new molecules into therapy and the shift of alloSCT to older age groups promises to improve patient survival and quality of life in the future.