Analysis Of Prognostic Factors In 28 Patients With CMML And Evaluate The Efficacy Of Different Therapies

Objective: We aim to analysis the prognostic factors of CMML patients,compare the prognostic scoring system combined with the specific circumstances of our hospital,and evaluate the efficacy of different therapies of decitabine and Traditional chemotherapy.Methods: From October 2009 to June 2017 a retrospective analysis including 28 patients diagnosed with CMML,whom received at least 2 courses of therapies and it was performed in the first affiliated hospital of Lanzhou University.Analysis of the clinical and laboratory data of 28 CMML patients,including gender,age,peripheral blood cells,bone marrow blasts,immunophenotype,karyotype analysis,gene mutation,risk stratification,therapy method and effect,survival time.Risk stratification was assessed on the basis of G-MDAPS,Mayo,GFM,and CPSS-Mol prognostic scoring system.At the same time,28 cases of CMML patients were divided into the experimental group(decitabine treatment)and the control group(traditional chemotherapy treatment)according to different therapies.Statistical analyses were performed using the statistical package for the social sciences(SPSS)software version 22.0,the threshold of statistical significance was P less than 0.05.Results: 1.Univariate analysis showed that age,leucocyte count,monocyte count,hemoglobin count,platelet count,lactate dehydrogenase,blood transfusion dependence,WHO classification,and FAB classification were showed prognostic value on OS(P<0.05).Multivariate analysis showed that age,high white blood cells,WHO classification(CMML-2)and blood transfusion dependency retained their significance in multivariate analysis(P= 0.001?0.003?0.001?0.022).2.All the four prognostic system showed the best value for predictive OS(P<0.001,<0.001,<0.001,<0.005)and make a distinction between high risk and low risk group(P= 0.014,0.011,0.004,0.008).CPSS�Mol showed a better predictive value for mortality(ROC area 0.596),and G-MDAPS showed a better predictive value for leukemia transformation(ROC area 0.773,0.693).3.The overall response rate(ORR)and complete remission rate(CR)were 54.5% and 18.2%.The ORR and CR of traditional chemotherapy are 23.5% and 5.9% respectively.There was no statistic difference in different therapies(P=0.313?0.100).The clinical benefit rate(CB)of the two treatment group are 36.4% and 5.9%(P=0.043).And the intermediate-1 risk group and lactate dehydrogenase>240U/L were more beneficial from decitabine(P=0.016,0.011).Conclusion: CMML patients with advanced age,higher leukocyte,WHO classification(CMML-2)and transfusion dependency showed independent prognostic value on OS.CPSS�Mol showed a better predictive value for mortality,G-MDAPS showed a better predictive value for leukemia transformation.The patients of intermediate-1 risk group of CPSS-Mol prognostic system and high lactate dehydrogenase were more beneficial from decitabine.