Pb2240: treatment outcome of chronic myelomonocytic leukemia; a single centre experience from pakistan

Topic: 16. Myeloproliferative neoplasms - Clinical Background: Chronic myelomonocytic leukemia (CMML) is an uncommon clonal hematopoietic disease characterized by an increase in monocytes and dysplasia of myeloid progenitor cells classified as myelodysplastic/myeloproliferative neoplasm (MDS/MPN). The accumulated clinical information and laboratory data on CMML demonstrate the development of the disease’s diagnosis and therapy. Aims: The study was conducted to observe the outcome of CMML patients in the stratified groups according to CMML type, karyotype and treatment. Methods: A cross sectional study was conducted at National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi Pakistan from 2018-2022. Approval from the Institutional ethics committee was obtained prior to the study. Baseline investigations were done and clinical parameters were recorded. Bone marrow biopsy samples were taken and stained by leishman stain. Cytogenetic analysis was performed on overnight, 24-h un-stimulated and 72-h stimulated bone marrow cultures using standard procedures. Descriptive statistics were reported by using SPSS version 23.0 Results: A total of 29 CMML patients were analyzed, median age was 63(28-85) years with male predominance (62%). MPN type was more prevalent 25(86%), 22(76%) patients had normal karyotype and 12(41%) were CMML-0 as per WHO classification. Overall Cytarabine was given in 8(28%) patents with MPN type, azacytidine to 2(7%) patients with MDS type and decitabine was offered to 13(52%) patients with MPN type and only a single MDS type patient received decitabine. Total deaths were observed in 14(44%) patients out of which 12(86%) had MPN type. Groups on the basis of CMML type, treatment and karyotype were stratified and deaths, post treatment infection and transfusion dependency were evaluated in each stratified group and no significant association (P value >0.05) was observed. The association of CMML type with the post treatment infections was found significant and it revealed that MPN type had more post treatment infections than MDS type (P value =0.042). Summary/Conclusion: This was one of the first studies conducted on CMML Pakistani patients and it was observed that although there was no significant association among the treatment groups yet decitabine was given in majority of MPN type subgroup and post treatment infections were prevalent. Further longitudinal studies with follow up data along with the integration of NGS for risk stratification would be a noteworthy addition. ` Keywords: Treatment, CMML