Clinical and demographic characteristics of 319 patients with de novo CMML and 39 patients with t-CMML
| Variable . | De novo CMML (N = 319) . | t-CMML (N = 39) . | P . |
|---|---|---|---|
| Median age, y (range) | 68 (23-89) | 69 (30-80) | .995 |
| Female | 101 (32) | 12 (31) | .910 |
| WHO classification | |||
| CMML-1 | 221 (69) | 18 (46) | .080 |
| CMML-2 | 95 (30) | 15 (38) | |
| Unknown | 3 (1) | 6 (15) | |
| Median WBC, ×103/µL (range) | 14.6 (1.1-223) | 11.3 (2.4-113.6) | .209 |
| Median HGB, g/dL (range) | 10.5 (5.1-17.1) | 10.8 (8.4-15.3) | .903 |
| Median PLT, ×103/µL (range) | 94.0 (5.0-809) | 90 (20-545) | .797 |
| Median AMC, ×103/µL (range) | 2.91 (0.02-101.76) | 2.81 (0.25-28.99) | .414 |
| Median ALC, ×103/µL (range) | 2.0 (0.08-13.5) | 1.67 (0.36-7.13) | .196 |
| IMCs | 215 (67) | 26 (68) | .899 |
| Median BM blast percentage (range) | 6 (0-19) | 7 (1-18) | .443 |
| Median LDH, IU/L (range) | 640 (191-7380) | 598 (327-3518) | .435 |
| Median β2MG, mg/dL (range) | 3.9 (1.2-21.4) | 3.7 (1.3-56.8) | .372 |
| Median lysozyme, µg/mL (range) | 20 (2.1-204.0) | 20.0 (10.6-34.5) | .918 |
| Cytogenetic abnormalities | |||
| Diploid | 209 (66) | 17 (44) | |
| -Y sole | 14 (4) | 0 (0) | |
| -Y plus 1 abn | 1 (0.3) | 0 (0) | |
| 3q sole | 2 (0.6) | 0 (0) | |
| del 5q/-5 sole | 1 (0.3) | 0 (0) | |
| del 5q/-5 plus 1 abn | 0 (0) | 0 (0) | |
| del 7q/-7 sole | 8 (3) | 1 (3) | |
| del 7q/-7 plus 1 abn | 9 (3) | 2 (5) | |
| +8 sole | 11 (3) | 0 (0) | |
| +8 plus 1 abn | 3 (0.9) | 0 (0) | |
| 9q sole | 1 (0.3) | 2 (5) | |
| 11q23 sole | 2 (0.6) | 0 (0) | |
| Del 12p sole | 2 (0.6) | 0 (0) | |
| Del 13q sole | 2 (0.6) | 2 (5) | |
| Del 20q sole | 6 (2) | 5 (13) | |
| del 20q plus 1 abn | 2 (0.6) | 0 (0) | |
| +21 sole | 4 (1) | 0 (0) | |
| +21 plus 1 abn | 1 (0.3) | 0 (0) | |
| Complex | 12 (4) | 5 (13) | |
| Other nonrecurrent abnormalities | 13 (4) | 0 (0) | |
| Unknown | 16 (5) | 5 (13) | |
| Cytogenetics risk category* | .011 | ||
| Low | 224 (74) | 17 (50) | |
| Intermediate | 36 (12) | 9 (26) | |
| High | 43 (14) | 8 (24) | |
| Molecular analysis, N/tested (%) | |||
| NRAS G12D | 46/251 (18) | 3/29 (10) | .251† |
| KRAS G12D | 15/251 (6) | 1/29 (3) | |
| FLT3-ITD | 10/268 (4) | 0/29 (0) | .606 |
| FLT3-D835 | 3/267 (1) | 0/29 (0) | .999 |
| JAK2 V617F | 18/149 (12) | 1/12 (8) | .999 |
| MDAPS-defined risk | .752 | ||
| Low | 105 (33) | 14 (37) | |
| Intermediate-1 | 99 (31) | 14 (37) | |
| Intermediate-2 | 65 (20) | 6 (16) | |
| High | 50 (16) | 4 (11) | |
| CPSS-defined risk | .010 | ||
| Low | 70 (25) | 1 (3) | |
| Intermediate-1 | 80 (29) | 13 (45) | |
| Intermediate-2 | 102 (37) | 10 (35) | |
| High | 25 (9) | 5 (17) | |
| Therapy‡ | .537 | ||
| BSC/CR | 112 (35) | 14 (36) | |
| HMA | 157 (49) | 16 (41) | |
| AML-like induction therapy | 15 (5) | 3 (8) | |
| iMiDs/TKIs | 35 (11) | 6 (15) | |
| SCT | 17 (5) | 5 (13) | .077 |
| Primary cancer types | |||
| Breast | NA | 5 (13) | |
| Prostate | NA | 12 (31) | |
| Hodgkin lymphoma | NA | 1 (3) | |
| Non-Hodgkin lymphoma | NA | 12 (31) | |
| Multiple myeloma | NA | 1 (3) | |
| Ovarian | NA | 2 (5) | |
| Head and neck/lung | NA | 3 (8) | |
| Gastrointestinal | NA | 1 (3) | |
| Unknown | NA | 2 (5) | |
| Exposure | |||
| Radiation only | NA | 15 (38) | |
| Chemotherapy or combined modality | NA | 24 (62) | |
| Exposure to alkylating agents | NA | 17 (44) | |
| Exposure to topoisomerase II inhibitor | NA | 4 (10) | |
| Autologous SCT | NA | 7 (18) | |
| Median latency, y (range)§ | NA | 6 (1-32) |
| Variable . | De novo CMML (N = 319) . | t-CMML (N = 39) . | P . |
|---|---|---|---|
| Median age, y (range) | 68 (23-89) | 69 (30-80) | .995 |
| Female | 101 (32) | 12 (31) | .910 |
| WHO classification | |||
| CMML-1 | 221 (69) | 18 (46) | .080 |
| CMML-2 | 95 (30) | 15 (38) | |
| Unknown | 3 (1) | 6 (15) | |
| Median WBC, ×103/µL (range) | 14.6 (1.1-223) | 11.3 (2.4-113.6) | .209 |
| Median HGB, g/dL (range) | 10.5 (5.1-17.1) | 10.8 (8.4-15.3) | .903 |
| Median PLT, ×103/µL (range) | 94.0 (5.0-809) | 90 (20-545) | .797 |
| Median AMC, ×103/µL (range) | 2.91 (0.02-101.76) | 2.81 (0.25-28.99) | .414 |
| Median ALC, ×103/µL (range) | 2.0 (0.08-13.5) | 1.67 (0.36-7.13) | .196 |
| IMCs | 215 (67) | 26 (68) | .899 |
| Median BM blast percentage (range) | 6 (0-19) | 7 (1-18) | .443 |
| Median LDH, IU/L (range) | 640 (191-7380) | 598 (327-3518) | .435 |
| Median β2MG, mg/dL (range) | 3.9 (1.2-21.4) | 3.7 (1.3-56.8) | .372 |
| Median lysozyme, µg/mL (range) | 20 (2.1-204.0) | 20.0 (10.6-34.5) | .918 |
| Cytogenetic abnormalities | |||
| Diploid | 209 (66) | 17 (44) | |
| -Y sole | 14 (4) | 0 (0) | |
| -Y plus 1 abn | 1 (0.3) | 0 (0) | |
| 3q sole | 2 (0.6) | 0 (0) | |
| del 5q/-5 sole | 1 (0.3) | 0 (0) | |
| del 5q/-5 plus 1 abn | 0 (0) | 0 (0) | |
| del 7q/-7 sole | 8 (3) | 1 (3) | |
| del 7q/-7 plus 1 abn | 9 (3) | 2 (5) | |
| +8 sole | 11 (3) | 0 (0) | |
| +8 plus 1 abn | 3 (0.9) | 0 (0) | |
| 9q sole | 1 (0.3) | 2 (5) | |
| 11q23 sole | 2 (0.6) | 0 (0) | |
| Del 12p sole | 2 (0.6) | 0 (0) | |
| Del 13q sole | 2 (0.6) | 2 (5) | |
| Del 20q sole | 6 (2) | 5 (13) | |
| del 20q plus 1 abn | 2 (0.6) | 0 (0) | |
| +21 sole | 4 (1) | 0 (0) | |
| +21 plus 1 abn | 1 (0.3) | 0 (0) | |
| Complex | 12 (4) | 5 (13) | |
| Other nonrecurrent abnormalities | 13 (4) | 0 (0) | |
| Unknown | 16 (5) | 5 (13) | |
| Cytogenetics risk category* | .011 | ||
| Low | 224 (74) | 17 (50) | |
| Intermediate | 36 (12) | 9 (26) | |
| High | 43 (14) | 8 (24) | |
| Molecular analysis, N/tested (%) | |||
| NRAS G12D | 46/251 (18) | 3/29 (10) | .251† |
| KRAS G12D | 15/251 (6) | 1/29 (3) | |
| FLT3-ITD | 10/268 (4) | 0/29 (0) | .606 |
| FLT3-D835 | 3/267 (1) | 0/29 (0) | .999 |
| JAK2 V617F | 18/149 (12) | 1/12 (8) | .999 |
| MDAPS-defined risk | .752 | ||
| Low | 105 (33) | 14 (37) | |
| Intermediate-1 | 99 (31) | 14 (37) | |
| Intermediate-2 | 65 (20) | 6 (16) | |
| High | 50 (16) | 4 (11) | |
| CPSS-defined risk | .010 | ||
| Low | 70 (25) | 1 (3) | |
| Intermediate-1 | 80 (29) | 13 (45) | |
| Intermediate-2 | 102 (37) | 10 (35) | |
| High | 25 (9) | 5 (17) | |
| Therapy‡ | .537 | ||
| BSC/CR | 112 (35) | 14 (36) | |
| HMA | 157 (49) | 16 (41) | |
| AML-like induction therapy | 15 (5) | 3 (8) | |
| iMiDs/TKIs | 35 (11) | 6 (15) | |
| SCT | 17 (5) | 5 (13) | .077 |
| Primary cancer types | |||
| Breast | NA | 5 (13) | |
| Prostate | NA | 12 (31) | |
| Hodgkin lymphoma | NA | 1 (3) | |
| Non-Hodgkin lymphoma | NA | 12 (31) | |
| Multiple myeloma | NA | 1 (3) | |
| Ovarian | NA | 2 (5) | |
| Head and neck/lung | NA | 3 (8) | |
| Gastrointestinal | NA | 1 (3) | |
| Unknown | NA | 2 (5) | |
| Exposure | |||
| Radiation only | NA | 15 (38) | |
| Chemotherapy or combined modality | NA | 24 (62) | |
| Exposure to alkylating agents | NA | 17 (44) | |
| Exposure to topoisomerase II inhibitor | NA | 4 (10) | |
| Autologous SCT | NA | 7 (18) | |
| Median latency, y (range)§ | NA | 6 (1-32) |
All data are no. of patients (%) unless otherwise specified.
ALC, absolute lymphocyte count; AMC, absolute monocyte count; β2MG, β2 microglobulin; BM, bone marrow; CPSS, CMML-specific prognostic scoring system; HGB, hemoglobin; IMCs, presence of immature myeloid cells in the peripheral blood; ITD, internal tandem duplication; LDH, lactate dehydrogenase; MDAPS, MD Anderson Prognostic Score; NA, not applicable; PLT, platelet count; SCT, stem cell transplant; WBC, white blood cell count.
Cytogenetic risk category was defined by CMML-specific cytogenetic risk category by Such et al.12
P value is for total RAS-mutated patients (both KRAS and NRAS).
Therapy was categorized into 4 groups. BSC/CR includes supportive care or cytoreductive therapy using hydroxyurea or oral etoposide. HMA include 5-azacitidine–based or decitabine-based therapy. AML-like induction therapy includes a regimen such as idarubicin and cytarabine combination. Others include immunomodulatory agents such as lenalidomide or thalidomide and TKIs (iMiDs/TKIs).
Time from initial chemotherapy or radiation treatment to t-CMML.