PROGNOSTIC VALUE OF MONOCYTE SUBSET DISTRIBUTION IN CHRONIC
MYELOMONOCYTIC LEUKEMIA (CMML)
Matthieu Jestin1, Sihem Tarfi1,2, Matthieu Duchmann3,4, Bouchra Badaoui1, Nicolas Freynet1, Ivan
Sloma1,2, Nathalie Droin5, Margot Morabito5, Sébastien Maury6, Pierre Fenaux7, Eric Solary5,8,9,
Dorothée Selimoglu-Buet5 and Orianne Wagner-Ballon1,2
(1)Département d'Hématologie et Immunologie biologiques, Hôpitaux universitaires Henri-Mondor (AP-HP),
Créteil, France, (2)INSERM U955 IMRB, UPEC, Créteil, France, (3)Laboratoire d'Hématologie,
Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France, (4)INSERM
U944, Institut de recherche Saint-Louis, Université de Paris, Paris, France, (5)INSERM U1287, Université
Paris-Saclay, Gustave Roussy Cancer Center, Villejuif, France, (6)Service d’Hématologie clinique,
Hôpitaux universitaires Henri-Mondor (AP-HP), Créteil, France, (7)Service d’Hématologie Clinique,
Hôpital Saint-Louis AP-HP, Paris, France, (8)Faculté de Médecine, Université Paris-Sud, Le Kremlin-
Bicêtre, Le Kremlin-Bicêtre, France, (9)Department of Clinical Hematology, Gustave Roussy Cancer
Center, Villejuif, France
Objectives: A relative increase in classical monocyte fraction (cMo, CD14++CD16-) ≥94% of
total peripheral blood monocytes distinguishes a CMML from a reactive monocytosis with a
high specificity and sensitivity. However, this diagnostic tool can be challenged by the co-occurrence
of an inflammatory disease as it lowers the cMo fraction. The present study
explores the prognostic value of the distribution of monocyte subset in the peripheral blood
of CMML patients.
Methods : We updated in June 2019 the outcome of CMML patients included between June
2012 and March 2017 in our previous studies. Flow cytometry analysis of peripheral blood
monocyte subsets had been performed at diagnosis and were reanalyzed centrally in a blind
fashion by a skilled operator.
Results: According to 2017 WHO criteria, 107 CMML patients (median age: 75 years, sex ratio:
2.2) were classified into 43 CMML-0, 48 CMML-1 and 16 CMML-2 with 79 dysplastic forms.
Median WBC, hemoglobin level and platelet count were 9.3 x109/L, 11.8 g/dL, and 120 x109/L,
respectively. The CPSS score, calculated in 101 cases, classified the patients into Low (44%),
Intermediate-1 (28%), Intermediate-2 (27%) and High (1%) categories. The median cMo
fraction was 96.9% with a cMo percentage ≥94% in 98 patients whereas the remaining
patients, referred thereafter as“inflammatory CMML”, displayed cMo<94% associated with a
bulbous aspect on flow cytometry profile (Figure1A,1B). The absolute count of cMo was
similar between inflammatory (1.6 x109/L) and classical (1.8 x109/L, p=0.65) CMML.
With a median follow-up of 26.7 months, 21 patients had received hypomethylating agents
and 3 were allograft. Eighteen patients had transformation to acute myeloid leukemia (AML)
and 40 died, mainly from AML progression. Median overall survival (OS) and AML-free survival
(AMLFS) were 40.3 and 40.1 months, respectively.
In a multivariate Cox model, a flow-defined inflammatory profile predicted poorer OS
(p=0.0019), independently of ASXL1 (p=0.029, mutated in 18 patients/62), hemoglobin level
(p=0.013) and platelet count (p=0.0002). Median OS for inflammatory CMML patients was
13.7 months compared to 42.2 months for other patients (Figure1C). A similar impact on
AMLFS was observed (Figure1D). Three variables were associated with the flow-defined
inflammatory profile: poorer cytogenetic risk (p=0.023), CPSS score (p=0.028) and GFM score
(p=0.014).
POSTER 5
SCIENTIFIC PROGRAMME
SESSION I
ETIOLOGY OF MDS
SESSION II
BIOLOGY OF MDS –
GENETIC ABNORMALITIES
SESSION III
BIOLOGY OF MDS:
STEM CELLS AND THE
MICROENVIRONMENT
SESSION IV
DIAGNOSTIC WORKUP
AND PROGNOSTIC
FACTORS IN MDS
SESSION V
SPECIFIC SUBTYPES
OF MDS, BASED ON
MORPHOLOGY AND
MOLECULAR BIOLOGY
SESSION VI
TREATMENT OF MDS
SESSION VII
CURRENT PROGRESS IN
THE TREATMENT OF MDS
SESSION VIII
FUTURE TREATMENTS
AND TREATMENT
STRATEGIES IN MDS
SESSION IX
LATE-BREAKING TALKS
SELECTED ABSTRACTS
FOR AN ORAL
PRESENTATION
SELECTED ABSTRACTS
AS E-POSTERS
DISCLOSURES