Patients With CMML Who Develop GVHD Less Likely to Relapse

By Cecilia Brown - October 5, 2022

Patients with chronic myelomonocytic leukemia (CMML) who developed graft-versus-host disease (GVHD) after transplant were less likely to relapse, according to recent research.

Luis Aguirre, MD, of the Moffitt Cancer Center in Tampa, Florida, and colleagues conducted the research and presented their findings at the Tenth Annual Meeting of the Society of Hematologic Oncology (SOHO).

The researchers retrospectively collected clinical and molecular data from 84 patients with CMML who received allogenic hematopoietic stem-cell transplantation (HSCT) between 1995 and 2022 at the Moffitt Cancer Center. Nearly half of patients (43%) had early-stage CMML, while 36% had blast-phase CMML and 18% had The median patient age at transplant was 63 years (range, 18-76 years). The median follow-up was 93 months.

Relapse occurred in 34% of patients, but patients who developed GVHD were significantly less likely to relapse, with no relapse occurring in 85.7% of patients who developed GVHD.

“I think that is related to the graft-versus-leukemia effect … and this is something that we have seen in multiple different studies, transplant patients who ended up developing acute or chronic graft-versus-host disease also were less likely to relapse,” Dr. Aguirre said during his poster presentation at the SOHO meeting.

Mutations in DNMT3A were associated with the risk of relapse (P=.04). The relapse rate for those with a lower blast percentage at time of transplant was 30% compared with 40% (P=.458). The number of treatments before transplant, donor type, stem-cell source, and type of conditioning regimen were not associated with the relapse rate.

The median overall survival (OS) was 62 months (95% CI, 35-89 months). Patients who received a transplant earlier had better outcomes, with a median OS of 202 months for those with early-stage CMML and a median OS of 62 months for those with blast-phase CMML (95% CI, 39-84 months; P=.019).

“Patients with CMML who went to transplant earlier in the disease course had better outcomes,” Dr. Aguirre and colleagues concluded. There was a trend toward better outcomes for those receiving intensive chemotherapy. [Complete response] was more likely with [cladribine, cytarabine, and granulocyte colony-stimulating factor] and 7+3 induction. Relapse was less likely for those who developed GVHD and more likely to be associated with DNMT3A mutations.”

Aguirre L, Ali N, Sallman D, et al. Outcome predictors and timing considerations for allogeneic stem cell transplantation in chronic myelomonocytic leukemia. Poster MDS-519. Presented at the Tenth Annual Meeting of the Society of Hematologic Oncology; September 28-October 1, 2022; Houston, TX.

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