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A multifactorial risk scoring system for the prediction of early relapse in CMML patients with allo-HSCT: a nationwide representative multicenter study

Bone Marrow Transplantation volume 60, pages 310–318 (2025)Cite this article

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Abstract

Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic stem cell malignancy and the only curable therapy is allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, allo-HSCT is not appropriate for all CMML patients, and relapse is the leading cause of treatment failure. This project conducted a nationwide multicenter real-world study to develop a novel prediction scoring system for early relapse. A total of 238 CMML patients from twenty-seven medical centers treated with allo-HSCT, and 307 adult patients with CMML who underwent allo-HSCT in a publicly available research dataset from the Center for International Blood and Marrow Transplantation Registry (CIBMTR) database were included. Independent prognostic factors for the early relapse of CMML posttransplantation were identified according to competing risk regression methods. Four prognostic factors were identified: bone marrow blasts >10% (hazard ratio [HR], 4.262; P = 0.014), age >60 years (HR, 6.221; P = 0.007), hemoglobin level <100 g/L (HR, 3.695; P = 0.004), and non TET2 gene mutation (HR, 3.425; P = 0.017). A risk-grading scoring system was developed based on the regression coefficients and patients were stratified into low-risk (0–1 point), intermediate-risk (1.5–2 points) and high-risk ( > 2 points) groups. The validated internal c-statistic was 0.767 (95% confidence interval [CI], 0.674–0.860), and the external c-statistic was 0.769 (95% CI, 0.703–0.836). In the derivation cohort, the cumulative incidence rates of early relapse in the low-risk, intermediate-risk, and high-risk groups were 1.35% (95% CI: 1–4%), 10.40% (95% CI: 4–16%), and 29.54% (95% CI: 16–39%) (P < 0.001), respectively. This scoring system can be utilized to early identification of patients at a high risk of relapse and contributing to the implementation of urgent medical support.

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Fig. 1: CIR according to the prediction model.
Fig. 2: ROC curve of the prediction scoring system in the derivation and validation cohorts.
Fig. 3: Calibration plot and decision curve analysis of the prediction scoring system in the derivation and validation cohorts.

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Data availability

The data are not publicly available due to their containing information that could compromise the privacy of research participants but are available on request from the corresponding author, Xiao-Hui Zhang, PhD, MD.

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Acknowledgements

This work was supported by the National Key Research and Development Program of China (No. 2021YFC2500304), the Key Program of National Natural Science Foundation of China (No. 82230004), National Natural Science of Foundation of China (No. 81970113) and Capital Health Research and Development of Special (No. 2022-1-4082).

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Author notes

  1. These authors contributed equally: Jian-Ying Zhou, Yu-Xiu Chen.

Authors and Affiliations

  1. Peking University People’s Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

    Jian-Ying Zhou, Yu-Xiu Chen, Yu-Hong Chen, Feng-Rong Wang, Yuan-Yuan Zhang, Xiao-Dong Mo, Wei Han, Jing-Zhi Wang, Yu Wang, Huan Chen, Xiang-Yu Zhao, Ying-Jun Chang, Kai-Yan Liu, Xiao-Jun Huang & Xiao-Hui Zhang

  2. Department of Hematology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China

    Hai-Long Yuan & Ming Jiang

  3. Department of Hematology, Xiangya Hospital of Central South University, Changsha, China

    Ya-Jing Xu

  4. Department of Hematology, Sichuan Academy of Medical Sciences, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China

    Xiao-Bing Huang

  5. Hematology section, Cancer Center, The First Hospital of Jilin University, Changchun, China

    Su-Jun Gao

  6. Department of Hematology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China

    Yi-Cheng Zhang

  7. Hematology Department, The 960th Hospital of The People’s Liberation Army (PLA) Joint Logistics Support Force, Jinan, China

    Fang Zhou

  8. Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Xian-Min Song

  9. Department of Hematology, Bone Marrow Transplant Center, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China

    Yi Luo

  10. Department of Hematology, Changhai Hospital, The Naval Medical University, Shanghai, China

    Jian-Min Yang

  11. Department of Hematology, Zhujiang Hospital of Southern Medical University, Guangzhou, China

    Yu-Hua Li

  12. Department of Hematology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China

    Shun-Qing Wang

  13. Department of Hematology, Peking University First Hospital, Beijing, China

    Yu-Jun Dong

  14. Xinqiao Hospital, The Third Military Medical University, Chongqing, China

    Xi Zhang & Yi-Mei Feng

  15. Department of Hematology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China

    Xin Du

  16. Department of Hematology, Jiangsu Province Hospital, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China

    Han Zhu

  17. Department of Hematology, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou, China

    Zun-Min Zhu

  18. Department of Hematology, School of First Affiliated Hospital of Shandong First Medical University, Shandong Province Qianfoshan Hospital, Jinan, China

    Ke-Hong Bi

  19. Department of Hematology, West China Hospital, Sichuan University, Chengdu, China

    Ting Niu

  20. Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

    Ding-Ming Wan

  21. Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

    Yi Chen

  22. Department of Hematology, The Second Affiliated Hospital (Tangdu Hospital) of Air Force Medical University, Xi’an, China

    Li Liu

  23. Department of Hematology, Western Theater General Hospital of the People’s Liberation Army of China, Chengdu, China

    Hai Yi

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  1. Jian-Ying Zhou
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Contributions

JYZ and XHZ contributed to the study design. JYZ, YXC, HLY, YJX, XBH, SJG, YCZ, FZ, XMS, YL, JMY, YHL, SQW, YJD, XZ, YMF, XD, HZ, ZMZ, KHB, MJ, TN, DMW, YC, LL and HY collected the data. JYZ, YXC, YHC, FRW, YYZ, and XDM performed data analysis. JYZ drafted and wrote the manuscript. WH, JZW, YW, HC, XYZ, YJC, KYL and XJH revised it critically. XHZ conceived and directed the study and revised the manuscript. The final version of the manuscript was critically reviewed and approved by all authors.

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Correspondence to Xiao-Hui Zhang.

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Zhou, JY., Chen, YX., Yuan, HL. et al. A multifactorial risk scoring system for the prediction of early relapse in CMML patients with allo-HSCT: a nationwide representative multicenter study. Bone Marrow Transplant 60, 310–318 (2025). https://doi.org/10.1038/s41409-024-02480-3

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