Impact of Hemoglobin, Leucocyte and Thrombocyte Levels at Diagnosis on the Survival Outcomes of Chronic Myeloid Leukemia Patients

Yıl 2024, , 78 - 82, 29.02.2024

Sinan Demircioğlu , Rafiye Ciftciler , Atakan Tekinalp , Taha Ulutan Kars

https://doi.org/10.54005/geneltip.1348459

Öz

Background:Since the development of tyrosine kinase inhibitors (TKIs), the prognosis for chronic myeloid leukemia (CML) has significantly improved. Several predicted prognostic scores and indicators at diagnosis have been used to predict the prognosis of chronic phase chronic myeloid leukemia (CML-CP) during the TKI period. When CML patients are first diagnosed, hemogram parameter aberrations are rather prevalent in clinical practice, although it is still unknown how those parameters affect the prognosis. This study aims to evaluate the hemogram parameters at diagnosis on the survival outcomes of CML-CP patients.
Materials and Methods:One hundred thirty-seven patients who were diagnosed with CML-CP and received treatment were assessed between the years 2006 and 2020.
Results:There were 65 (47.4%) males and 72 (52.6%) females with a median age of 50 (range: 18-78) years at diagnosis. Median hemoglobin level was 12.1 gr/dL (4.3-17.4), leucocyte count was 66.2 ×109 /L (7.5-520.2), and thrombocyte count was 362 ×109 /L (18-3.496) for all patients. The median progression-free survival (PFS) was 16.7 months 16.7 (2.0-106.4) and the median overall survival (OS) was 63.8 months (0.43-166.2) for all patients.
Conclusion:This study is valuable in terms of predicting the prognosis of CML patients with hemoglobin, leukocyte, and platelet values at the time of diagnosis. While emphasizing the importance of platelet count at the time of diagnosis, similar to the previously defined risk scores, it showed that leukocyte and hemoglobin values at the time of diagnosis did not have a statistically significant effect on OS and PFS.

Anahtar Kelimeler

Chronic myeloid leukemia, hemoglobin, leucocyte, thrombocyte, risk score

Kronik Miyeloid Lösemi Hastalarının Tanı Sırasındaki Hemoglobin, Lökosit ve Trombosit Düzeylerinin Sağkalım Sonuçlarına Etkisi

Öz

Giriş ve Amaç: İmatinib ve diğer tirozin kinaz inhibitörlerinin (TKİ’ler) geliştirilmesinden bu yana, kronik miyeloid löseminin (KML) prognozu önemli ölçüde iyileşti. TKİ döneminde daha az tedavi yanıtları ve sonuçları olan kronik faz kronik miyeloid lösemi (KML-KF) bireylerini belirlemek için tanı sırasında tahmin edilen çeşitli prognostik skorlar ve göstergeler kullanıldı. KML hastalarına ilk tanı konduğunda klinik pratikte hemogram parametrelerinde anormallikler oldukça yaygındır, ancak bu parametrelerin prognozu nasıl etkilediği henüz bilinmemektedir. Bu çalışmanın amacı KML-KF hastalarının tanı anındaki hemoglobin, lökosit ve trombosit düzeylerinin sağkalım sonuçlarına etkisini değerlendirmektir.
Gereç ve Yöntem: 2006-2020 yılları arasında KML-KF tanısı alan ve tedavi gören 137 hasta değerlendirildi.
Bulgular: Tanı anındaki ortanca yaş 50 (18-78) yıl olan 84 (%45,9) erkek ve 99 (%54,1) kadın hasta değerlendirildi. Tüm hastaların ortanca hemoglobin düzeyi 12,1 gr/dL (4,3-17,4), lökosit sayısı 66,2×109/L (7,5-520,2), trombosit sayısı ise 362×109/L (18-3,496) saptandı. Medyan progresyonsuz sağkalım (PFS) tüm hastalar için 16,7 ay 16,7 (2,0-106,4) ve medyan genel sağkalım (OS) 63,8 ay (0,43-166,2) idi.
Sonuç: Bu çalışma KML hastalarının tanı anındaki hemoglobin, lökosit ve trombosit değerleri ile prognozunu öngörmesi açısından değerlidir. Tanı anında trombosit sayısının önemi vurgulanırken, daha önce tanımlanan risk skorlarına benzer şekilde, tanı anındaki lökosit ve hemoglobin değerlerinin OS ve PFS üzerinde istatistiksel olarak anlamlı bir etkisinin olmadığı gösterildi.

Anahtar Kelimeler

Chronic myeloid leukemia, hemoglobin, leucocyte, thrombocyte, risk score

Kaynakça

• Minciacchi VR, Kumar R, Krause DS. Chronic Myeloid Leukemia: A Model Disease of the Past, Present and Future. Cells. 2021;10(1).
• Jain P, Kantarjian H, Patel KP, Gonzalez GN, Luthra R, Shamanna RK, et al. Impact of BCR-ABL transcript type on outcome in patients with chronic-phase CML treated with tyrosine kinase inhibitors. Blood, The Journal of the American Society of Hematology. 2016;127(10):1269-75.
• Hochhaus A, Baccarani M, Silver RT, Schiffer C, Apperley JF, Cervantes F, et al. European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia. Leukemia. 2020;34(4):966-84.
• Pfirrmann M, Baccarani M, Saußele S, Guilhot J, Cervantes F, Ossenkoppele G, et al. Prognosis of long-term survival considering disease-specific death in patients with chronic myeloid leukemia. Leukemia. 2016;30(1):48-56.
• Cross N, White H, Müller M, Saglio G, Hochhaus A. Standardized definitions of molecular response in chronic myeloid leukemia. Leukemia. 2012;26(10):2172-5.
• Hughes TP, Kaeda J, Branford S, Rudzki Z, Hochhaus A, Hensley ML, et al. Frequency of major molecular responses to imatinib or interferon alfa plus cytarabine in newly diagnosed chronic myeloid leukemia. New England Journal of Medicine. 2003;349(15):1423-32.
• Hughes T, Deininger M, Hochhaus A, Branford S, Radich J, Kaeda J, et al. Monitoring CML patients responding to treatment with tyrosine kinase inhibitors: review and recommendations for harmonizing current methodology for detecting BCR-ABL transcripts and kinase domain mutations and for expressing results. Blood. 2006;108(1):28-37.
• De Lavallade H, Apperley JF, Khorashad JS, Milojkovic D, Reid AG, Bua M, et al. Imatinib for newly diagnosed patients with chronic myeloid leukemia: incidence of sustained responses in an intention-to-treat analysis. Journal of Clinical Oncology. 2008;26(20):3358-63.
• Sokal JE, Baccarani M, Tura S, Fiacchini M, Cervantes F, Rozman C, et al. Prognostic discrimination among younger patients with chronic granulocytic leukemia: relevance to bone marrow transplantation. 1985.
• Hasford J, Pfirrmann M, Hehlmann R, Allan NC, Baccarani M, Kluin-Nelemans JC, et al. A new prognostic score for survival of patients with chronic myeloid leukemia treated with interferon alfa Writing Committee for the Collaborative CML Prognostic Factors Project Group. JNCI: Journal of the National Cancer Institute. 1998;90(11):850-9.
• Hasford J, Baccarani M, Hoffmann V, Guilhot J, Saussele S, Rosti G, et al. Predicting complete cytogenetic response and subsequent progression-free survival in 2060 patients with CML on imatinib treatment: the EUTOS score. Blood, The Journal of the American Society of Hematology. 2011;118(3):686-92.
• Luatti S, Castagnetti F, Marzocchi G, Baldazzi C, Gugliotta G, Iacobucci I, et al. Additional chromosomal abnormalities in Philadelphia-positive clone: adverse prognostic influence on frontline imatinib therapy: a GIMEMA Working Party on CML analysis. Blood, The Journal of the American Society of Hematology. 2012;120(4):761-7.
• Iurlo A, Ubertis A, Artuso S, Bucelli C, Radice T, Zappa M, et al. Comorbidities and polypharmacy impact on complete cytogenetic response in chronic myeloid leukemia elderly patients. European Journal of Internal Medicine. 2014;25(1):63-6.
• Faber E, Mužík J, Koriťáková E, Nečasová T, Jindra P, Cmunt E, et al. Significance of anemia in patients with CML at diagnosis and during the treatment with imatinib outside the clinical trials: CAMELIA registry experience. 2015.
• Jabbour E, Kantarjian HM, Saglio G, Steegmann JL, Shah NP, Boqué C, et al. Early response with dasatinib or imatinib in chronic myeloid leukemia: 3-year follow-up from a randomized phase 3 trial (DASISION). Blood, The Journal of the American Society of Hematology. 2014;123(4):494-500.