Ribera et al developed a prognostic model for patients with chronic myelomonocytic leukemia (CMML). This can help identify patients who may benefit from more aggressive management. The authors are from the University of Barcelona in Spain.


Parameters associated with unfavorable prognosis:

(1) monocyte count in 10^9/L

(2) splenic size





monocyte count

(value) * 10^9/L


splenic size

not palpable



palpable splenomegaly



X =

= (3.0515 * ((LOG10(points for the monocyte count)) - 0.71) + (1.3316 * ((points for splenic size) - 0.24))



• The original equation has 2 ambiguous features (monocyte count, log function). The choices above are the only options giving results similar to those described on page 309.


hazard ratio function =

= EXP(X)



• A high hazard ratio function is associated with poor survival.

• The hazard ratio function is higher with a high monocyte count and larger spleen.

• The cutoff for risk groups was 1. A value <= 1 indicates a low risk group and > 1 indicates a high risk group.

• The median survival for the low risk group was 16.5 months and for the high risk groups 5.6 months. (NOTE: Current survival may be better due to improved management.)


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