{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T11:07:12Z","timestamp":1787828832296,"version":"build-2784847793"},"reference-count":47,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2017,5,26]],"date-time":"2017-05-26T00:00:00Z","timestamp":1495756800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Hypomethylating agents (HMA) are the most commonly used therapeutic intervention in chronic myelomonocytic leukemia (CMML). Due to the lack of CMML\u2010specific clinical trials, the impact of these agents in the natural history of CMML is not fully understood. We present the largest retrospective series of CMML (n\u2009=\u2009151) treated with HMA. Mean age at diagnosis was 69 years (range 50\u201088). According to the CMML\u2010specific prognostic scoring system (CPSS): 17 (15%) were low\u2010risk, 45 (39%) intermediate\u20101 risk, 42 (36%) intermediate\u20102, and 12 (10%) high\u2010risk. 35 (23%) patients received single agent azacitidine, 73 (48%) single agent decitabine, and 43 (29%) combinations. With a median follow\u2010up of 17 months, overall response rate (ORR) was 75%, with 41% achieving complete response (CR). Median overall survival (OS) was 24 months (95%CI: 20\u201028) and event\u2010free survival 14 months (95%CI: 11\u201017). By multivariate analysis, age\u2009&lt;\u200970 years, higher levels of hemoglobin, absence of blast in peripheral blood and lower CPSS cytogenetic risk predicted for better OS. CR was significantly higher in those patients treated with decitabine (58.3%) when compared with azacitidine (20.6%) (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001). 13 patients (9%) received allo\u2010SCT after a median of 4 cycles of HMA. 66 patients (50%) had HMA failure: 26 primary (34%) and 50 secondary (66%), including 35 (46%) that transformed to AML. Outcomes after HMA failure were poor with OS of 7 months (95%CI: 3\u201012). In conclusion, HMA are effective in CMML but new agents and combinations are needed. This data could be a benchmark for further drug development in CMML.<\/jats:p>","DOI":"10.1002\/ajh.24735","type":"journal-article","created":{"date-parts":[[2017,3,28]],"date-time":"2017-03-28T18:01:27Z","timestamp":1490724087000},"page":"599-606","source":"Crossref","is-referenced-by-count":45,"title":["Natural history of chronic myelomonocytic leukemia treated with hypomethylating agents"],"prefix":"10.1002","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2478-5354","authenticated-orcid":false,"given":"Ana","family":"Alfonso","sequence":"first","affiliation":[{"name":"Departments of Leukemia University of Texas, MD Anderson Cancer Center Houston TX 77015 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Montalban\u2010Bravo","sequence":"additional","affiliation":[{"name":"Departments of Leukemia University of Texas, MD Anderson Cancer Center Houston TX 77015 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Departments of Leukemia University of Texas, MD Anderson Cancer Center Houston TX 77015 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4465-6119","authenticated-orcid":false,"given":"Elias J.","family":"Jabbour","sequence":"additional","affiliation":[{"name":"Departments of Leukemia University of Texas, MD Anderson Cancer Center Houston TX 77015 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tapan","family":"Kadia","sequence":"additional","affiliation":[{"name":"Departments of Leukemia University of Texas, MD Anderson Cancer Center Houston TX 77015 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhad","family":"Ravandi","sequence":"additional","affiliation":[{"name":"Departments of Leukemia University of Texas, MD Anderson Cancer Center Houston TX 77015 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Cortes","sequence":"additional","affiliation":[{"name":"Departments of Leukemia University of Texas, MD Anderson Cancer Center Houston TX 77015 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeev","family":"Estrov","sequence":"additional","affiliation":[{"name":"Departments of Leukemia University of Texas, MD Anderson Cancer Center Houston TX 77015 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gautam","family":"Borthakur","sequence":"additional","affiliation":[{"name":"Departments of Leukemia University of Texas, MD Anderson Cancer Center Houston TX 77015 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1670-6513","authenticated-orcid":false,"given":"Naveen","family":"Pemmaraju","sequence":"additional","affiliation":[{"name":"Departments of Leukemia University of Texas, MD Anderson Cancer Center Houston TX 77015 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Konopleva","sequence":"additional","affiliation":[{"name":"Departments of Leukemia University of Texas, MD Anderson Cancer Center Houston TX 77015 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Bueso\u2010Ramos","sequence":"additional","affiliation":[{"name":"Departments of Hematopathology The University of Texas, MD Anderson Cancer Center Houston TX 77015 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherry","family":"Pierce","sequence":"additional","affiliation":[{"name":"Departments of Leukemia University of Texas, MD Anderson Cancer Center Houston TX 77015 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1908-3307","authenticated-orcid":false,"given":"Hagop","family":"Kantarjian","sequence":"additional","affiliation":[{"name":"Departments of Leukemia University of Texas, MD Anderson Cancer Center Houston TX 77015 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Garcia\u2010Manero","sequence":"additional","affiliation":[{"name":"Departments of Leukemia University of Texas, MD Anderson Cancer Center Houston TX 77015 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,5,26]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues","author":"Jaffe ES.","year":"2001"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-03-643544"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2009-03-209262"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2013.084061"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-01-134858"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.1994.tb06734.x"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.23751"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-08-518886"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2012-06-440347"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11864-002-0011-6"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.2002.03552.x"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2010.09.018"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.12073"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2015.12.009"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13576"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.21792"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2002.04.117"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(09)70003-8"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.22457"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-05-352039"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2010.030957"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.3109\/10428194.2012.719617"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2012.04.024"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2007.08.004"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2013.01.004"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2014.01.006"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2012-08-452938"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2013.88"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V89.6.2079"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23697"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V99.3.840"},{"key":"e_1_2_6_33_1","unstructured":"International Standing Committee on Human Cytogenetic Nomenclature. Shaffer LG Tommerup N. ISCN 2005: an international system for human cytogenetic nomenclature (2005): recommendations of the International Standing Committee on Human Cytogenetic Nomenclature. Basel; Farmington CT: Karger;2005. 130 p. p."},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.23846"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-10-607341"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2005-10-4149"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.35.8135"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.25247"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.1982.tb02771.x"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1080\/1042819042000207271"},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.3109\/10428194.2012.730615"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2014.09.003"},{"key":"e_1_2_6_43_1","first-page":"766","article-title":"Chronic myelomonocytic leukemia","volume":"4","author":"Storniolo AM","year":"1990","journal-title":"Leukemia."},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24650"},{"key":"e_1_2_6_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2015.08.031"},{"key":"e_1_2_6_46_1","doi-asserted-by":"crossref","unstructured":"CalvoX NomdedeuM SantacruzR et al. Comparison of three prognostic scoring systems in a series of 146 cases of chronic myelomonocytic leukemia (CMML): MD Anderson prognostic score (MDAPS) CMML\u2010specific prognostic scoring system (CPSS) and Mayo prognostic model. A detailed review of prognostic factors in CMML. Leukemia research2015. doi:10.1016\/j.leukres.2015.05.017","DOI":"10.1016\/j.leukres.2015.05.017"},{"key":"e_1_2_6_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2013.07.007"},{"key":"e_1_2_6_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(16)00009-7"}],"container-title":["American Journal of Hematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fajh.24735","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ajh.24735","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T16:32:16Z","timestamp":1695573136000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ajh.24735"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5,26]]},"references-count":47,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2017,7]]}},"alternative-id":["10.1002\/ajh.24735"],"URL":"https:\/\/doi.org\/10.1002\/ajh.24735","archive":["Portico"],"relation":{},"ISSN":["0361-8609","1096-8652"],"issn-type":[{"value":"0361-8609","type":"print"},{"value":"1096-8652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,5,26]]}}}