Impact of age on the cumulative risk of transformation in patients with chronic myelomonocytic leukaemia
Sigrid Machherndl‐Spandl, Eva Jäger, Agnes Barna, Michael Gurbisz, Renate Marschon, Temeida Graf, Elmir Graf, Christoph Geissler, Gregor Hoermann, Thomas Nösslinger, Michael Pfeilstöcker, Peter Bettelheim, Otto Zach, Ansgar Weltermann, Sonja Heibl, Josef Thaler, Armin Zebisch, Heinz Sill, Reinhard Stauder, Gerald Webersinke, Rajko Kušec, Ernst Ulsperger, Bruno Schneeweiß, Leopold Öhler, Ulrich Germing, Peter Valent, Heinz Tüchler, Klaus Geißler
Abstract
In older patients with chronic myelomonocytic leukaemia (CMML) and limited life expectancy due to age and or comorbidities, it is particularly important to consider the risk of transformation for individualised treatment decisions. There is limited information on potential differences between younger and older CMML patients regarding the cumulative risk of transformation as well as haematological, molecular and biologic characteristics. We analysed data from the Austrian Biodatabase for CMML (ABCMML) to compare these parameters in 518 CMML patients. Categorisation of patients into 3 age-related groups: <60 years, 60-79 years and ≥80 years, showed a significantly lower risk of transformation at higher age by competing risk analysis, with a 4-year risk of 39%, 23% and 13%, respectively (P < .0001). The lower probability of transformation was associated with a lower percentage of blast cells in the peripheral blood (PB) of older patients. Furthermore, we provide a simple score based on age, PB blasts and platelet counts that allowed us to define subgroups of CMML patients with a different cumulative transformation risk, including a low-risk group with a transformation risk of only 5%. Our findings may facilitate reasonable treatment decisions in elderly patients with CMML.