Assessment Of Prognosis

Because optimal CMML management is still being developed and a multitude of investigational options are available, the ability to assess the risk-to-benefit ratio of any particular treatment for individual patients is important. This assessment has been facilitated by the identification of both disease- and patient-related variables associated with outcome, as measured by survival. In turn, these variables have led to the development of prognostic scoring systems for CMML that allow identification of patients with various life expectancies and risks of succumbing to the disease if untreated.4

The most significant variables negatively associated with survival, as determined by a multivariate analysis of a large number of patients with well-defined CMML, are the degree of anemia; the presence of circulating immature WBC; the absolute blood lymphocyte count; an increased percentage of bone marrow blasts; and an abnormal karyotype.4 Although age was not a significant prognostic variable in that multivariate analysis, the goals of optimal management are modified by age-related considerations (e.g., quality of life vs potentially limited prolongation of survival), and age should always be considered, along with auxiliary medical problems and patients' wishes, in choosing the approach for optimal management.

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