The following article features coverage from the 2021 Annual Meeting of the Society of Hematologic Oncology (SOHO). Click here to read more of Cancer Therapy Advisor’s conference coverage.

Researchers have identified clinical and molecular features that could help predict which patients with chronic myelomonocytic leukemia (CMML) will have an indolent disease course and can delay treatment.

These findings were presented at the Annual Meeting of the Society of Hematologic Oncology (SOHO) by Luis E. Aguirre, MD, of Moffitt Cancer Center in Tampa, Florida.

Dr Aguirre noted that CMML is characterized by clinical heterogeneity and generally poor outcomes. Longitudinal assessment of disease features is important for predicting which patients will have an indolent course and which patients will progress, he said.


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With the goal of identifying those predictive features, Dr Aguirre and colleagues evaluated baseline clinical and molecular characteristics of 729 patients with CMML who were treated at the Moffitt Cancer Center between 1995 and 2020.

The researchers compared characteristics of 606 patients who had non-indolent CMML and required treatment less than 3 years after diagnosis with characteristics of 123 patients (17%) who had indolent CMML and were under observation for more than 3 years.

The median overall survival was 32.4 months for the entire cohort. It was 70.3 months for patients with indolent disease and 25.3 months for patients with non-indolent disease (P <.001).

The following characteristics were associated with non-indolent CMML and the need to start treatment within 3 years:

  • Elevated white blood cell (P <.001), absolute neutrophil (P <.001), monocyte (P <.001), and absolute lymphocyte (P =.004) counts at baseline
  • Elevated levels of lactate dehydrogenase (P =.001) and ferritin (P <.001)
  • The presence of blasts in the peripheral blood (P <.001)
  • Increased blasts (P <.001) and cellularity in marrow biopsies (P =.009)
  • Transfusion dependence (P <.001 for red blood cells and platelets)
  • Higher rate of transformation to acute myeloid leukemia (P =.004)
  • NRAS mutations (P =.004).

On the other hand, the following characteristics were associated with indolent CMML:

  • Higher baseline platelet counts (P =.022) and hemoglobin levels (P =.008)
  • Less profound cytopenias (P <.001)
  • Lower-risk disease according to all prognostic risk models (P <.001 for all)
  • Mutations in JAK2, SF3B1, and IDH2 (P <.005).

Based on these findings, Dr Aguirre concluded that “a small proportion of patients” will have indolent CMML, and some clinical and molecular features at the time of diagnosis may help clinicians identify these patients.

Read more of Cancer Therapy Advisor’s coverage of SOHO 2021 by visiting the conference page.

Reference

Aguirre LE, Ball S, Ali NA, et al. Assessment of baseline clinical and molecular characteristics in indolent chronic myelomonocytic leukemia. Paper presented at: Annual Meeting of the Society of Hematologic Oncology (SOHO); September 8-11, 2021.