1. Impact of a novel prognostic model on allogeneic hematopoietic stem cell transplantation outcomes in patients with CMML.
- Author
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Zhou JY, Wang S, Yuan HL, Xu YJ, Huang XB, Gao SJ, Zhang YC, Zhou F, Liu Y, Song XM, Cai Y, Liu XL, Luo Y, Yang LX, Yang JM, Wang LB, Li YH, Huang R, Wang SQ, Zhou M, Dong YJ, Wang Q, Zhang X, Feng YM, Du X, Ling W, Zhu H, Zhu ZM, Chen XL, Wang SY, Meng FK, Bi KH, Huang N, Jiang M, Niu T, Ji J, Wan DM, Bian ZL, Chen Y, Liu L, Yan XQ, Yang X, Yi H, Wei XD, Li X, Cheng Q, Yuan CL, Wang W, Zhou YH, Ye BD, Ding J, Wu YJ, Huang QS, Zhu XL, Chen YH, He Y, Wang FR, Zhang YY, Mo XD, Han W, Wang JZ, Wang Y, Chen H, Zhao XY, Chang YJ, Liu KY, Huang XJ, and Zhang XH
- Subjects
- Humans, Prognosis, Transplantation, Homologous adverse effects, Retrospective Studies, Leukemia, Myelomonocytic, Chronic, Hematopoietic Stem Cell Transplantation adverse effects, Graft vs Host Disease etiology
- Abstract
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., (© 2023 Wiley Periodicals LLC.)
- Published
- 2023
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