Journal of Clinical Oncology, Vol 16, 3782-3787, Copyright © 1998 by American Society of Clinical Oncology
Determinants of prognosis in late chronic-phase chronic myelogenous leukemia
J Rodriguez, J Cortes, T Smith, S O'Brien, MB Rios, M Talpaz and H Kantarjian
Department of Leukemia, The University of Texas, M.D. Anderson Cancer Center, Houston, USA.
PURPOSE: Since interferon alfa (IFN-A) became an established treatment in
chronic myelogenous leukemia (CML), more patients are referred to tertiary
centers in late chronic phase (ie, > 12 months after diagnosis). Trials
conducted in this phase cannot be evaluated precisely unless the features
that determine prognosis in late chronic- phase CML are identified. The
purpose of this study is to define the prognostic determinants of late
chronic-phase CML. PATIENTS AND METHODS: From 1980 to 1997,257 consecutive
CML patients referred in late chronic phase were studied. Their clinical
characteristics at the time of referral and their association with survival
were investigated. A staging model was designed. RESULTS: The median
survival from time of referral was 43 months. Pretreatment characteristics
associated with worse outcome included older age, poor performance status,
splenomegaly, low albumin level, high percentage of blasts or basophils in
peripheral blood (PB) or bone marrow, longer duration of chronic phase, and
poor-risk group as defined by the Synthesis model. Prior exposure to IFN-A
was not associated with worse outcome. By multivariate analysis,
characteristics associated with shorter survival were age of 60 years or
older, time from diagnosis of 3 years or greater, performance status of 1
or greater, PB basophils of 7% or greater, spleen 10 cm or greater, PB
blasts 3% or greater, and albumin level less than 4 g/dL. A model that
included age, duration of chronic phase, performance status, and PB
basophils was generated. Patients with no, one, two, or three or greater
adverse factors had median survivals of 71, 49, 26, and 19 months,
respectively. CONCLUSION: A staging model for late chronic-phase CML can
stratify patients in four groups with significantly different outcomes. If
confirmed in independent populations, such a model could be considered in
the analysis of future trials of treatment strategies in late chronic-phase
CML.
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