Impact of a novel prognostic model on allogeneic hematopoietic stem cell transplantation outcomes in patients with CMML.
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Zhou Jian-Ying, Wang Song, Yuan Hai-Long, Xu Ya-Jing, Huang Xiao-Bing, Gao Su-Jun, Zhang Yi-Cheng, Zhou Fang, Liu Yue, Song Xian-Min, Cai Yu, Liu Xiao-Liang, Luo Yi, Yang Lu-Xin, Yang Jian-Min, Wang Li-Bing, Li Yu-Hua, Huang Rui, Wang Shun-Qing, Zhou Ming, Dong Yu-Jun, Wang Qian, Zhang Xi, Feng Yi-Mei, Du Xin, Ling Wei, Zhu Han, Zhu Zun-Min, Chen Xiang-Li, Wang Shi-Yu, Meng Fan-Kai, Bi Ke-Hong, Huang Ning, Jiang Ming, Niu Ting, Ji Jie, Wan Ding-Ming, Bian Zhi-Lei, Chen Yi, Liu Li, Yan Xue-Qian, Yang Xi, Yi Hai, Wei Xu-Dong, Li Xin, Cheng Qian, Yuan Cheng-Lu, Wang Wen, Zhou Yu-Hong, Ye Bao-Dong, Ding Jing, Wu Ye-Jun, Huang Qiu-Sha, Zhu Xiao-Lu, Chen Yu-Hong, He Yun, Wang Feng-Rong, Zhang Yuan-Yuan, Mo Xiao-Dong, Han Wei, Wang Jing-Zhi, Wang Yu, Chen Huan, Zhao Xiang-Yu, Chang Ying-Jun, Liu Kai-Yan, Huang Xiao-Jun, Zhang Xiao-Hui
Аннотация
Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic stem cell malignancy, and allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only curable treatment. The outcomes after transplant are influenced by both disease characteristics and patient comorbidities. To develop a novel prognostic model to predict the post-transplant survival of CMML patients, we identified risk factors by applying univariable and multivariable Cox proportional hazards regression to a derivation cohort. In multivariable analysis, advanced age (hazard ratio [HR] 3.583), leukocyte count (HR 3.499), anemia (HR 3.439), bone marrow blast cell count (HR 2.095), and no chronic graft versus host disease (cGVHD; HR 4.799) were independently associated with worse survival. A novel prognostic model termed ABLAG (Age, Blast, Leukocyte, Anemia, cGVHD) was developed and the points were assigned according to the regression equation. The patients were categorized into low risk (0-1), intermediate risk (2, 3), and high risk (4-6) three groups and the 3-year overall survival (OS) were 93.3% (95%CI, 61%-99%), 78.9% (95%CI, 60%-90%), and 51.6% (95%CI, 32%-68%; p < .001), respectively. In internal and external validation cohort, the area under the receiver operating characteristic (ROC) curves of the ABLAG model were 0.829 (95% CI, 0.776-0.902) and 0.749 (95% CI, 0.684-0.854). Compared with existing models designed for the nontransplant setting, calibration plots, and decision curve analysis showed that the ABLAG model revealed a high consistency between predicted and observed outcomes and patients could benefit from this model. In conclusion, combining disease and patient characteristic, the ABLAG model provides better survival stratification for CMML patients receiving allo-HSCT.