Prognostic Score Including Gene Mutations in Chronic Myelomonocytic Leukemia

作者：Raphaël Itzykson, Olivier Kosmider, Aline Renneville, Véronique Gelsi‐Boyer, Manja Meggendorfer, Margot Morabito, Céline Berthon, Lionel Adès, Pierre Fenaux, Odile Beyne‐Rauzy, Norbert Vey, Thorsten Braun, Torsten Haferlach, François Dreyfus, Nicholas C.P. Cross, Claude Preudhomme, Olivier Bernard, Michaëla Fontenay, William Vainchenker, Susanne Schnittger, Daniel Birnbaum, Nathalie M Droin, Éric Solary · 发表于：Journal of Clinical Oncology · 年份：2013 · DOI：10.1200/jco.2012.47.3314 · 被引用次数：548 · 研究领域：Acute Myeloid Leukemia Research、Myeloproliferative Neoplasms: Diagnosis and Treatment、Chronic Myeloid Leukemia Treatments

PURPOSE: Several prognostic scoring systems have been proposed for chronic myelomonocytic leukemia (CMML), a disease in which some gene mutations-including ASXL1-have been associated with poor prognosis in univariable analyses. We developed and validated a prognostic score for overall survival (OS) based on mutational status and standard clinical variables. PATIENTS AND METHODS: We genotyped ASXL1 and up to 18 other genes including epigenetic (TET2, EZH2, IDH1, IDH2, DNMT3A), splicing (SF3B1, SRSF2, ZRSF2, U2AF1), transcription (RUNX1, NPM1, TP53), and signaling (NRAS, KRAS, CBL, JAK2, FLT3) regulators in 312 patients with CMML. Genotypes and clinical variables were included in a multivariable Cox model of OS validated by bootstrapping. A scoring system was developed using regression coefficients from this model. RESULTS: ASXL1 mutations (P < .0001) and, to a lesser extent, SRSF2 (P = .03), CBL (P = .003), and IDH2 (P = .03) mutations predicted inferior OS in univariable analysis. The retained independent prognostic factors included ASXL1 mutations, age older than 65 years, WBC count greater than 15 ×10(9)/L, platelet count less than 100 ×10(9)/L, and anemia (hemoglobin < 10 g/dL in female patients, < 11g/dL in male patients). The resulting five-parameter prognostic score delineated three groups of patients with median OS not reached, 38.5 months, and 14.4 months, respectively (P < .0001), and was validated in an independent cohort of 165 patients (P < .0001). CONCLUSION: A n...