Volume 98, Issue 9 p. 1394-1406
RESEARCH ARTICLE

Impact of a novel prognostic model on allogeneic hematopoietic stem cell transplantation outcomes in patients with CMML

Jian-Ying Zhou

Jian-Ying Zhou

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Song Wang

Song Wang

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Hai-Long Yuan

Hai-Long Yuan

Department of Hematology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China

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Ya-Jing Xu

Ya-Jing Xu

Department of Hematology, Xiangya Hospital of Central South University, Changsha, China

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Xiao-Bing Huang

Xiao-Bing Huang

Department of Hematology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China

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Su-Jun Gao

Su-Jun Gao

Hematology Section, Cancer Center, The First Hospital of Jilin University, Changchun, China

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Yi-Cheng Zhang

Yi-Cheng Zhang

Department of Hematology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China

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Fang Zhou

Fang Zhou

Hematology Department, The 960th Hospital of The People's Liberation Army (PLA) Joint Logistics Support Force, Jinan, China

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Yue Liu

Yue Liu

Hematology Department, The 960th Hospital of The People's Liberation Army (PLA) Joint Logistics Support Force, Jinan, China

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Xian-Min Song

Xian-Min Song

Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Yu Cai

Yu Cai

Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Xiao-Liang Liu

Xiao-Liang Liu

Hematology Section, Cancer Center, The First Hospital of Jilin University, Changchun, China

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Yi Luo

Yi Luo

Department of Hematology, Bone Marrow Transplant Center, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China

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Lu-Xin Yang

Lu-Xin Yang

Department of Hematology, Bone Marrow Transplant Center, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China

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Jian-Min Yang

Jian-Min Yang

Department of Hematology, Changhai Hospital, The Naval Medical University, Shanghai, China

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Li-Bing Wang

Li-Bing Wang

Department of Hematology, Changhai Hospital, The Naval Medical University, Shanghai, China

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Yu-Hua Li

Yu-Hua Li

Department of Hematology, Zhujiang Hospital of Southern Medical University, Guangzhou, China

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Rui Huang

Rui Huang

Department of Hematology, Zhujiang Hospital of Southern Medical University, Guangzhou, China

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Shun-Qing Wang

Shun-Qing Wang

Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China

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Ming Zhou

Ming Zhou

Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China

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Yu-Jun Dong

Yu-Jun Dong

Department of Hematology, Peking University First Hospital, Beijing, China

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Qian Wang

Qian Wang

Department of Hematology, Peking University First Hospital, Beijing, China

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Xi Zhang

Xi Zhang

Xinqiao Hospital, The Third Military Medical University, Chongqing, China

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Yi-Mei Feng

Yi-Mei Feng

Xinqiao Hospital, The Third Military Medical University, Chongqing, China

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Xin Du

Xin Du

Department of Hematology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China

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Wei Ling

Wei Ling

Department of Hematology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China

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Han Zhu

Han Zhu

Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China

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Zun-Min Zhu

Zun-Min Zhu

Department of Hematology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China

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Xiang-Li Chen

Xiang-Li Chen

Department of Hematology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China

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Shi-Yu Wang

Shi-Yu Wang

Department of Hematology, Xiangya Hospital of Central South University, Changsha, China

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Fan-Kai Meng

Fan-Kai Meng

Department of Hematology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China

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Ke-Hong Bi

Ke-Hong Bi

Department of Hematology, School of First Affiliated Hospital of Shandong First Medical University, Shandong Province Qianfoshan Hospital, Jinan, China

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Ning Huang

Ning Huang

Department of Hematology, School of First Affiliated Hospital of Shandong First Medical University, Shandong Province Qianfoshan Hospital, Jinan, China

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Ming Jiang

Ming Jiang

Department of Hematology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China

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Ting Niu

Ting Niu

Department of Hematology, West China Hospital, Sichuan University, Chengdu, China

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Jie Ji

Jie Ji

Department of Hematology, West China Hospital, Sichuan University, Chengdu, China

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Ding-Ming Wan

Ding-Ming Wan

Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

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Zhi-Lei Bian

Zhi-Lei Bian

Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

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Yi Chen

Yi Chen

Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

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Li Liu

Li Liu

Department of Hematology, The Second Affiliated Hospital (Tangdu Hospital) of Air Force Medical University, Xi'an, China

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Xue-Qian Yan

Xue-Qian Yan

Department of Hematology, The Second Affiliated Hospital (Tangdu Hospital) of Air Force Medical University, Xi'an, China

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Xi Yang

Xi Yang

Department of Hematology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China

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Hai Yi

Hai Yi

Department of Hematology, Western Theater General Hospital of the People's Liberation Army of China, Chengdu, China

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Xu-Dong Wei

Xu-Dong Wei

Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China

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Xin Li

Xin Li

Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha, China

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Qian Cheng

Qian Cheng

Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha, China

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Cheng-Lu Yuan

Cheng-Lu Yuan

Department of Hematology, Qilu Hospital, Shandong University, Jinan, China

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Wen Wang

Wen Wang

Department of Hematology, Qilu Hospital, Shandong University, Jinan, China

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Yu-Hong Zhou

Yu-Hong Zhou

Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China

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Bao-Dong Ye

Bao-Dong Ye

Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China

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Jing Ding

Jing Ding

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Ye-Jun Wu

Ye-Jun Wu

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Qiu-Sha Huang

Qiu-Sha Huang

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Xiao-Lu Zhu

Xiao-Lu Zhu

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Yu-Hong Chen

Yu-Hong Chen

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Yun He

Yun He

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Feng-Rong Wang

Feng-Rong Wang

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Yuan-Yuan Zhang

Yuan-Yuan Zhang

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Xiao-Dong Mo

Xiao-Dong Mo

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Wei Han

Wei Han

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Jing-Zhi Wang

Jing-Zhi Wang

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Yu Wang

Yu Wang

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Huan Chen

Huan Chen

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Xiang-Yu Zhao

Xiang-Yu Zhao

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Ying-Jun Chang

Ying-Jun Chang

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Kai-Yan Liu

Kai-Yan Liu

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Xiao-Jun Huang

Xiao-Jun Huang

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

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Xiao-Hui Zhang

Corresponding Author

Xiao-Hui Zhang

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

Correspondence

Xiao-Hui Zhang, No. 11 Xizhimen South St, Xicheng District, Beijing 100044, China.

Email: zhangxh@bjmu.edu.cn

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First published: 27 June 2023
Citations: 1

Jian-Ying Zhou and Song Wang contributed equally to this work.

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.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author, Xiao-Hui Zhang, PhD, MD. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

The full text of this article hosted at iucr.org is unavailable due to technical difficulties.