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Myelodysplastic syndrome

Prognostic value of monocyte subset distribution in chronic myelomonocytic leukemia: results of a multicenter study

Leukemia volume 35, pages 893–896 (2021)Cite this article

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A number of prognostic scores with similar performance have been proposed in CMML [10]. Among them is the CMML-specific prognostic scoring system (CPSS), which relies on French–American–British and WHO CMML subtypes, red blood cell transfusion dependency, or hemoglobin count, and the Spanish cytogenetic risk stratification system [11]. ASXL1 mutations, which have been invariably associated with a poor outcome, were the first molecular events incorporated in prognostication tools, including the Groupe Francophone des Myélodysplasies (GFM) score and others [12,13,14]. By contrast, the prognostic value of the distribution of monocyte subset in the peripheral blood of CMML patients has not been explored so far.

In the present study, after local ethical committee’s agreement, we updated in June 2019 the outcome of 107 CMML patients (median age: 75 years [interquartile range, 67–83], sex ratio: 2.2) included between June 2012 and March 2017 in our previous studies by four centers [2, 5]. Flow cytometric analysis of peripheral blood monocyte subsets had been performed at diagnosis, i.e., ±3 months from initial bone marrow examination. According to 2017 WHO criteria [1], this series included 43 CMML-0 (40%), 48 CMML-1 (45%), and 16 CMML-2 (15%) (Supplementary Table 1). Seventy-nine patients (74%) displayed a dysplastic form of the disease, 6 (6%) had therapy-related CMML, and 10 (9%) had evolved from a previous myelodysplastic syndrome. Median WBC, hemoglobin level, and platelet count were 9.3 × 109/L [5.9–13.6], 11.8 g/dL [9.7–13.2], and 120 × 109/L [70–209], respectively. The karyotype was normal in 70% of the 101 patients (94%) with available information. Hence, their CPSS score was low (44%), intermediate-1 (28%), intermediate-2 (27%), and high (1%). A frame-shift or non-sense mutation in ASXL1 gene was identified in 18 of the 62 (29%) patients with available information at diagnosis, stratifying them as low (55%), intermediate (39%), or high (6%) risk patients according to the GFM score. Among patients with available next-generation sequencing analyses (n = 47), mutations in NRAS, RUNX1, and SETBP1 genes, which are included in the CPSS-Mol [14], were detected in 5 (11%), 4 (9%), and 2 (4%) patients, respectively.

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Fig. 1: Flow cytometric profiles and outcome of patients with classical CMML and flow cytometry-defined inflammatory CMML.

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Groupe Francophone des Myélodysplasies (GFM)

P. Fenaux7, N. Vey10, L. Adès7, A. Guerci11, F. Chermat7, M. Fontenay12, S. Raynaud13, C. Preudhomme14, E. Solary5,8,9, T. Braun15, O. Beynerauzy16, R. Itzykson7, S. Park17, O. Kosmider12, T. Cluzeau13, A. Renneville14

Author information

Authors and Affiliations

  1. AP-HP, Hôpitaux Universitaires Henri-Mondor, Département d’Hématologie et Immunologie Biologiques, 94010, Créteil, France

    Matthieu Jestin, Sihem Tarfi, Bouchra Badaoui, Nicolas Freynet, Violaine Tran Quang, Ivan Sloma & Orianne Wagner-Ballon

  2. Univ Paris Est Créteil, INSERM, IMRB, Equipe 9, 94010, Créteil, France

    Sihem Tarfi, Violaine Tran Quang, Ivan Sloma & Orianne Wagner-Ballon

  3. Univ Paris, INSERM U944, Institut de Recherche Saint-Louis, 75010, Paris, France

    Matthieu Duchmann

  4. AP-HP, Hôpital Saint-Louis, Laboratoire d’Hématologie, 75010, Paris, France

    Matthieu Duchmann

  5. Univ Paris-Saclay, INSERM U1287, Gustave Roussy Cancer Center, 94800, Villejuif, France

    Nathalie Droin, Margot Morabito, Eric Solary, Dorothée Selimoglu-Buet & E. Solary

  6. AP-HP, Hôpitaux Universitaires Henri-Mondor, Service d’Hématologie Clinique, 94010, Créteil, France

    Mathieu Leclerc & Sébastien Maury

  7. AP-HP, Hôpital Saint-Louis, Service d’Hématologie Clinique, 75010, Paris, France

    Pierre Fenaux, P. Fenaux, L. Adès, F. Chermat & R. Itzykson

  8. Univ Paris-Sud, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France

    Eric Solary & E. Solary

  9. Gustave Roussy Cancer Center, Department of Clinical Hematology, 94800, Villejuif, France

    Eric Solary & E. Solary

  10. Hôpital Paoli-Calmettes, Marseille, France

    N. Vey

  11. CHU Nancy-Brabois, Vandœuvre, France

    A. Guerci

  12. AP-HP, Hôpital Cochin, Paris, France

    M. Fontenay & O. Kosmider

  13. CHU Nice, Nice, France

    S. Raynaud & T. Cluzeau

  14. CHU Lille, Lille, France

    C. Preudhomme & A. Renneville

  15. AP-HP, Hôpital Avicenne, Bobigny, France

    T. Braun

  16. IUCT, Toulouse, France

    O. Beynerauzy

  17. CHU Grenoble, Grenoble, France

    S. Park

Authors
  1. Matthieu Jestin
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  2. Sihem Tarfi
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  14. Dorothée Selimoglu-Buet
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Consortia

on behalf of the Groupe Francophone des Myélodysplasies (GFM)

  • P. Fenaux
  • , N. Vey
  • , L. Adès
  • , A. Guerci
  • , F. Chermat
  • , M. Fontenay
  • , S. Raynaud
  • , C. Preudhomme
  • , E. Solary
  • , T. Braun
  • , O. Beynerauzy
  • , R. Itzykson
  • , S. Park
  • , O. Kosmider
  • , T. Cluzeau
  •  & A. Renneville

Contributions

MJ collected clinical and biological annotations on patients, drew the figures, and helped writing the paper. ST, BB, NF, VTQ, and DS-B performed and analyzed the experiments. MD performed statistical analysis. IS and ND performed mutational analysis. MM prepared samples. ML, SM, PF, and ES provided patient samples. ES obtained the grants and critically reviewed the article. DS-B helped conceiving the study, analyzed data, and helped writing the paper. OW-B conceived the study, analyzed data, and wrote the paper. All authors revised and approved the manuscript.

Corresponding author

Correspondence to Orianne Wagner-Ballon.

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Conflict of interest

OW-B, DS-B, ND, and ES have a patent issued, relevant to the work. The other authors declare no conflict of interest.

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Members of the Groupe Francophone des Myélodysplasies (GFM) are listed at the end of paper.

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Jestin, M., Tarfi, S., Duchmann, M. et al. Prognostic value of monocyte subset distribution in chronic myelomonocytic leukemia: results of a multicenter study. Leukemia 35, 893–896 (2021). https://doi.org/10.1038/s41375-020-0955-1

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