TY - JOUR
T1 - Association of bone marrow fibrosis with inferior survival outcomes in chronic myelomonocytic leukemia
AU - Khan, Maliha
AU - Muzzafar, Tariq
AU - Kantarjian, Hagop
AU - Badar, Ifra
AU - Short, Nicholas
AU - Wang, Xuemei
AU - Chamoun, Kamal
AU - Jain, Preetesh
AU - DiNardo, Courtney
AU - Pemmaraju, Naveen
AU - Bose, Prithviraj
AU - Borthakur, Gautam
AU - Cortes, Jorge
AU - Verstovsek, Srdan
AU - Garcia-Manero, Guillermo
AU - Estrov, Zeev
N1 - Publisher Copyright:
© 2018, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - The impact of bone marrow fibrosis grade on the prognosis of patients with chronic myelomonocytic leukemia (CMML) remains controversial. Therefore, we examined the records of 82 patients diagnosed with CMML at our institution and summarized baseline characteristics and molecular profiles by subgroups of absent or mild (grades 0/1) and moderate (grade 2) fibrosis. Cox proportional hazards models were constructed to assess the prognostic significance of fibrosis grade. Grade 2 fibrosis was identified in 63 patients (76.8%), grade 1 in 16 patients (19.5%), and grade 0 in 3 patients (3.7%). Grade 2 fibrosis was associated with reduced hemoglobin levels (median 9.75 vs 11.0 g/dL in grade 0/1; p = 0.04) and increased percentages of ringed sideroblasts (7.5 vs 0%; p = 0.008). In multivariable analysis, grade 2 fibrosis was an independent predictor of poor overall survival (OS; 95% CI 1.32–6.35; HR 2.90; p = 0.008), but not event-free survival (EFS; 95% CI 0.62–2.67; HR 1.28; p = 0.50). Absolute neutrophil count (ANC) was found to impact OS (95% CI 1.01–1.09; HR 1.05; p = 0.009), while both ANC (95% CI 1.00–1.07; HR 1.04; p = 0.04) and peripheral blood blast percentage (95% CI 1.02–1.32; HR 1.16; p = 0.02) impacted EFS. These results implicate fibrosis grade is an important indicator of prognosis, with high-grade fibrosis predicting inferior survival. Given the prevalence of marrow fibrosis in CMML, fibrosis grading should be incorporated into prognostic assessment and therapeutic decision-making.
AB - The impact of bone marrow fibrosis grade on the prognosis of patients with chronic myelomonocytic leukemia (CMML) remains controversial. Therefore, we examined the records of 82 patients diagnosed with CMML at our institution and summarized baseline characteristics and molecular profiles by subgroups of absent or mild (grades 0/1) and moderate (grade 2) fibrosis. Cox proportional hazards models were constructed to assess the prognostic significance of fibrosis grade. Grade 2 fibrosis was identified in 63 patients (76.8%), grade 1 in 16 patients (19.5%), and grade 0 in 3 patients (3.7%). Grade 2 fibrosis was associated with reduced hemoglobin levels (median 9.75 vs 11.0 g/dL in grade 0/1; p = 0.04) and increased percentages of ringed sideroblasts (7.5 vs 0%; p = 0.008). In multivariable analysis, grade 2 fibrosis was an independent predictor of poor overall survival (OS; 95% CI 1.32–6.35; HR 2.90; p = 0.008), but not event-free survival (EFS; 95% CI 0.62–2.67; HR 1.28; p = 0.50). Absolute neutrophil count (ANC) was found to impact OS (95% CI 1.01–1.09; HR 1.05; p = 0.009), while both ANC (95% CI 1.00–1.07; HR 1.04; p = 0.04) and peripheral blood blast percentage (95% CI 1.02–1.32; HR 1.16; p = 0.02) impacted EFS. These results implicate fibrosis grade is an important indicator of prognosis, with high-grade fibrosis predicting inferior survival. Given the prevalence of marrow fibrosis in CMML, fibrosis grading should be incorporated into prognostic assessment and therapeutic decision-making.
KW - Bone marrow fibrosis
KW - CMML
KW - Fibrosis grade
KW - Prognosis
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U2 - 10.1007/s00277-018-3289-6
DO - 10.1007/s00277-018-3289-6
M3 - Article
C2 - 29557496
AN - SCOPUS:85046036977
SN - 0939-5555
VL - 97
SP - 1183
EP - 1191
JO - Annals of Hematology
JF - Annals of Hematology
IS - 7
ER -