PROGNOSIS OF CHRONIC MYELOMONOCYTIC LEUKEMIA

Background, Cytopenia caused by ineffective hematopoiesis and monocyte overproduction coexist in CMML, providing grounds for discussion to s upporters of a dysplastic versus a proliferative identity for CMML, Fo llow-up information from a large series of patients may contribute to clarifying the position of this infrequent disease. Methods. We analyz ed data from 77 patients followed in five institutions, Thirty-two var iables were studied for their influence an survival and on progression to acute leukemia by univariate and multivariate analysis, For some p arameters, we performed a quartile analysis to reveal a possible non-m onotonic influence on survival. Results. Median survival was 17 months . Evolution to acute leukemia (ANLL) occurred in 11 patients (14%) wit hin a median time of 8 months. Multivariate analysis assigned a poorer prognosis to patients presenting with thrombocytopenia, anemia and le ukocytosis. Thrombocytopenia and the presence of circulating blasts we re risk factors for transformation to ANLL, while raised serum asparta te transaminase at diagnosis seemed to be associated with a lower prob ability of blastic evolution. The Bournemouth score for CMML proved to be a valid tool for predicting survival but not acute transformation. Conclusions. CMML is a severe disease. The prognostic independence of cytopenia (anemia, thrombocytopenia) and leukocytosis underlines the coexistence of aspects typical of myelodysplastic and myeloproliferati ve syndromes.