Cervantes and Rozman studied prognostic factors in patients with chronic myelogenous leukemia using multivariate analysis.
Patients with CML who were Philadelphia chromosome negative (11.5% of patients in series) had a poor prognosis.
• These patients tend to show a more rapid evolution to the blastic phase.
Parameters associated with poor prognosis in patients with Philadelphia chromosome positive CML:
(1) splenomegaly (spleen palpable)
(2) hepatomegaly (liver palpable)
(3) erythroid precursors circulating in blood
(4) marrow myeloblasts > 5%
|
Parameters for Philadelphia chromosome positive CML |
Finding |
Value |
|
splenomegaly (spleen palpable) |
present |
1 |
|
|
absent |
0 |
|
hepatomegaly (liver palpable) |
present |
1 |
|
|
absent |
0 |
|
erythroid precursors circulating in blood |
present |
1 |
|
|
absent |
0 |
|
marrow myeloblasts |
> 5% |
1 |
|
|
<= 5% |
0 |
number of prognostic factors present =
= (splenomegaly value) + (hepatomegaly value) + (erythroid precursor value) + (marrow myeloblast value)
LN (relative hazard) =
= (0.73760 * ((splenomegaly value) - 0.77)) + (0.52298 * ((hepatomegaly value) - 0.48)) + (0.88523* ((erythroid precursor value) - 0.52)) + (1.04238* ((marrow myeloblast value) - 0.17))
relative hazard =
= EXP(equation above)
Interpretation:
• If Philadelphia chromosome negative, patient had a poor prognosis
• If Philadelphia chromosome positive, the outcome depended on the number of poor prognostic factors present.
For Philadelphia chromosome positive patients:
• minimum LN(relative hazard): -1.46; relative hazard = 0.23
• maximum LN(relative hazard): 1.73; relative hazard = 5.65
|
Prognostic Factors Present |
Risk Status |
Stage |
|
0-1 |
low risk |
I |
|
2 |
intermediate risk |
II |
|
3-4 |
high risk |
III |
|
Stage |
LN(relative hazard) |
|
I |
-1.46 to -0.41 |
|
II |
-0.20 to 0.47 |
|
III |
0.69 to 1.73 |
Specialty: Hematology Oncology
