Page 18 - Haematologica March 2020

Editorials
Table 2. Schematic representation of the relationships between clinical and hematologic characteristics, cytogenetics, somatic mutations, prog- nostic scoring systems and transplant outcomes in patients with chronic myelomonocytic leukemia.
ECOG: Eastern Cooperative Oncology Group; PS: Performance Status; CPSS: CMML-specific prognostic scoring system; MDAPS: MD Anderson prognostic score; RBC: red blood cells; Hb: hemoglobin; WBC: white blood cells; Abn: abnormalities; Chr: chromosome; HCT: hematopoietic cell transplant
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time points of the course of the disease.
However, even though NGS studies could therefore be
used to select a group of high-risk CMML patients for transplantation, our view is that it might still be prema- ture to incorporate the results of NGS techniques into the decision-making process for CMML patients undergoing allogeneic HCT. The main reasons are that NGS tech- niques and results are not well standardized, their repro- ducibility is unproven, the characterization of allele vari- ants as pathogenic is not homogenously defined, and the variant allele frequency threshold used to define the pres- ence of mutations is widely variable (5% in the series by Woo et al.) Furthermore, the impact of co-occurring muta- tions on prognosis is still unclear.19 Additionally, the value of molecular profiling for treatment decision-making in CMML patients is diminished by the limited number of treatment alternatives and because there is no single somatic mutation that favors the use of a particular treat- ment approach.19
In conclusion, molecular profiling will likely emerge in the near future as highly valuable for planning transplan- tation in CMML patients, adding up to other well-recog- nized patient and disease characteristics such as higher- risk CPSS and MDAPS categories and HCT-Cormorbidity Index. Prospective cooperative studies focused on NGS
results before and after transplantation and involving large numbers of patients will be eventually required to improve the cure rate afforded by allogeneic HCT in CMML.
Acknowledgments
This study was supported by research funding from Innovative Medicines Initiative 2 Joint Undertaking under HARMONY grant agreement n. 116026. This Joint Undertaking receives support from the European Union’s Horizon 2020 Research and Innovation Program and EFPIA; FEDER funds (CIBERONC (CB16/12/00284)), “Fundación Española de Hematología (FEHH)”; “Instituto de Salud Carlos III” grants PI16/011113, PI16/00665, and PI18/01472; and from the “Consellería de Educación, Cultura y Deporte” PROMETEOII/2015/008 and GVA/2018//004.
References
1. Such E, Cervera J, Costa D, et al. Cytogenetic risk stratification in chronic myelomonocytic leukemia. Haematologica. 2011;96(3):375- 383.
2. Itzykson R, Kosmider O, Renneville A, et al. Prognostic score includ- ing gene mutations in chronic myelomonocytic leukemia. J Clin Oncol. 2013;31(19):2428-2436.
3. Patnaik MM, Itzykson R, Lasho TL, et al. ASXL1 and SETBP1 muta-
haematologica | 2020; 105(3)