Does stringent cytoreduction improve survival in myeloproliferative chronic myelomonocytic leukemia? a correlative study on the dacota trial.

作者：Dorothée Selimoglu‐Buet, Sylvie Chevret, Valeria Santini, Sylvain Thépot, Margot Morabito, Lionel Adès, Lucie Laplane, Aristoteles Giagounidis, Nathalie Droin, Michael Lübbert, Rosa Sapena, Stanislas Nimubona, José Miguel Torregrosa Diaz, Ulrich Germing, Anna Maria Pelizzari, Sophie Park, Nadja Jäkel, Georgia Metzgeroth, Francesco Onida, Franciane Paul, Andrea Patriarca, Aspasia Stamatoulas Bastard, Katharina S. Götze, Fatiha Chermat, Uwe Platzbecker, Pierre Fenaux, Éric Solary, Raphaël Itzykson · 发表于：Blood · 年份：2025 · DOI：10.1182/blood-2025-791 · 被引用次数：2 · 研究领域：Acute Myeloid Leukemia Research、Myeloproliferative Neoplasms: Diagnosis and Treatment、Multiple Myeloma Research and Treatments

Abstract Background. Myeloproliferation at diagnosis is an adverse prognostic factor in CMML. Cytoreduction with hydroxyurea (HY) is considered palliative but decitabine (DAC) failed to improve survival over HY in advanced proliferative CMML in the randomized DACOTA trial (PMID 36455187). Whether resolution of myeloproliferation improves prognosis independently of bone marrow (BM) response is unknown. Multiparameter flow cytometry (MFC) reveals pathognomonic accumulation of CD14+/CD16- classical monocytes (cMo,) and variably, of CD45+CD66b+CD15+CD14- immature granulocytes (iGRAN) at CMML diagnosis. These flow-defined cell populations have not yet been studied as biomarkers of treatment response. Objectives. To inspect the prognostic value of WBC and absolute monocyte counts (AMC) and of MFC-defined cMo and iGRANs at the 3- and 6- cycle evaluations in the DACOTA trial (NCT02214407). Methods. MFC assessment of cMo and iGRAN was done centrally as published (25852055, 39545419). Survival analyses were done using landmarks at the 3- or 6-cycle evaluation visit. Main results of DACOTA were previously reported (36455187) Results. Of 170 patients (pts) with advanced proliferative CMML randomized in DACOTA, 120 (DAC n=63, HY n=57, M/F 83/37, median age 73y) were evaluated after 3 cycles with BM aspiration and complete blood count (CBC), including 79 with centralized MFC. Median WBC (DAC 32.7 x109/L; HY 31.2 x109/L), CPSS risk (int2/high; DAC 54%, HY 51%) and overall survival (OS) from...