Moderate anemia at diagnosis is an independent prognostic marker of the EUTOS, Sokal, and Hasford scores for survival and treatment response in chronic-phase, chronic myeloid leukemia patients with frontline imatinib

Abstract

Objectives: This study aimed to examine the prognostic value of anemia for the diagnosis of chronic myeloid leukemia in the chronic phase (CML-CP) receiving imatinib.

Methods: One hundred and fifty-four CML-CP patients were enrolled. The influences of moderate anemia with hemoglobin (Hb) < 10 g/dl, four scoring systems, and the early molecular response at 3 months (BCR-ABL ≤10%; 3M-EMR) on the achievement of a deep molecular response (DMR, MR4.5), progression-free survival (PFS), event-free survival (EFS), and overall survival (OS) were compared.

Results: Moderate anemia was identified in 44 (28.6%) patients. These patients had more aggressive baseline features and higher risks, as assessed by scoring systems, and less favorable treatment responses vs those without anemia, including 3M-EMR (50.0% vs 69.1%), a complete cytogenetic response at 6 months (20.5% vs 50.9%), and a major molecular response at 12 months (22.5% vs 45.2%), with a median follow-up of 54.0 months. Furthermore, an Hb of 10 g/dl better distinguished DMR, EFS, PFS, and OS than the EUTOS, Sokal, and Hasford scores, and better predicted the responses and survivals in combination with 3M-EMR than 3M-EMR alone.

Conclusions: This finding highlights the significance of anemia in CML-CP, and suggests that patients with anemia at diagnosis should be carefully monitored and might benefit from more potent TKIs if not achieving 3M-EMR.

Keywords:

• Chronic myeloid leukemia
• anemia
• scoring systems
• prognosis

Transparency

Declaration of funding

This work was supported by grants from the Taipei Veterans General Hospital (grant number V104C-151) and from the Taiwan Clinical Oncology Research Foundation and the Chong Hin Loon Memorial Cancer and Biotherapy Research Center of the National Yang-Ming University.

Declaration of financial/other relationships

The authors declare that they have no conflict of interest. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

We wish to thank Ching-Fen Yang, the hematopathlogist in our institution for interpretation of the bone marrow samples.