In a nutshell
This study compared different treatments for patients with chronic myelomonocytic leukemia (CMML). The data showed that hypomethylating agents (HMA) improved the outcomes compared with other treatments in these patients.
Some background
Chronic myelomonocytic leukemia (CMML) is a type of cancer that starts in blood-forming cells of the bone marrow and enters the blood. It affects mainly older adults and can be challenging to treat. CMML is divided into myelodysplastic (too many white blood cells) and myeloproliferative (abnormal and immature white blood cells)
Hypomethylating agents (HMA) are drugs that block DNA methylation which prevents the spreading of cancerous cells. Decitabine (Dacogen) and azacitidine (Vidaza) are HMAs. HMAs have been approved for the treatment of myelodysplastic CMML patients. However, those studies were based on little clinical data. Hydroxyurea (HU; Hydrea), a chemotherapy drug remains the recommended therapy for patients with myeloproliferative CMML. Whether HMAs provide a benefit in different subgroups of patients with CMML compared with other chemotherapy treatments is still unknown.
Methods & findings
This study involved 886 patients with CMML. 412 patients received HMAs, 391 patients received HU, and 83 patients received intensive chemotherapy treatment. The average follow-up time was 23.4 months from diagnosis and 16.2 months from the start of treatment.
The average overall survival for patients treated with HU was 15.6 months compared to 20.7 months with HMA. The average overall survival for patients treated with intensive chemotherapy was 14 months compared to 20.7 months with HMAs.
In patients with myeloproliferative CMML, the average OS was 12·6 months versus 17·6 months for patients treated with hydroxyurea versus HMA, and 12·3 months versus 17·6 months for intensive chemotherapy versus HMA. HMAs were associated with a 39% higher survival compared to HU and 55% higher survival compared to intensive therapy.
In patients with higher-risk CMML and those with myeloproliferative CMML, the average time to transformation to acute myeloid leukemia (AML) for patients treated with HU was 11.5 months compared to 18.3 months with HMAs.
The bottom line
This study concluded that HMAs led to better treatment outcomes in patients with higher-risk CMML leukemia and myeloproliferative CMML. The authors suggested that HMAs should be supplemented with hydroxyurea as a treatment option.
The fine print
This study looked back in time at medical records. Some information might have been incomplete.
Published By :
The Lancet. Haematology
Date :
Feb 01, 2021
