Abstract：
BACKGROUND: Chronic myelomonocytic leukemia (CMML) is a rare and likely underdiagnosed hematologic malignancy. Due to its rarity and nuances in diagnosis, many patients are referred to tertiary referral centers, although many continue to be cared for in the community setting. Given discrepancies in outcomes based on facility type in related myeloid malignancies, we hypothesized that CMML patients treated at academic centers may have improved survival as compared to patients treated at nonacademic centers (NACs).
METHODS: Using the National Cancer Database (NCDB), we identified 6290 patients with CMML and collected data on demographics, comorbidities, treatment, and survival. We also performed a propensity matched analysis to control for baseline differences.
RESULTS: We found that patients at academic centers had higher median overall survival (OS) (17.7 months vs 14.7 months) and 5-year OS (19.1% vs 15.3%) than patients at NACs. In addition, patients treated at an academic center were also more likely to receive hematopoietic stem cell transplant as compared to those treated at NACs. Time to treatment initiation was overall similar between academic and NACs.
CONCLUSIONS: Our study of one of the largest available datasets of CMML patients supports the importance of referring CMML patients to academic centers upon diagnosis to optimize outcomes in this rare hematologic malignancy.
METHODS: Using the National Cancer Database (NCDB), we identified 6290 patients with CMML and collected data on demographics, comorbidities, treatment, and survival. We also performed a propensity matched analysis to control for baseline differences.
RESULTS: We found that patients at academic centers had higher median overall survival (OS) (17.7 months vs 14.7 months) and 5-year OS (19.1% vs 15.3%) than patients at NACs. In addition, patients treated at an academic center were also more likely to receive hematopoietic stem cell transplant as compared to those treated at NACs. Time to treatment initiation was overall similar between academic and NACs.
CONCLUSIONS: Our study of one of the largest available datasets of CMML patients supports the importance of referring CMML patients to academic centers upon diagnosis to optimize outcomes in this rare hematologic malignancy.
摘要：
背景：慢性粒单核细胞白血病（CMML）是一种罕见且可能未被诊断的血液系统恶性肿瘤。由于其诊断的稀有性和细微差别，许多患者被转诊到三级转诊中心，尽管许多人继续在社区环境中得到照顾。鉴于相关髓系恶性肿瘤的设施类型的结果差异，我们假设,与在非学术中心(NACs)接受治疗的患者相比,在学术中心接受治疗的CMML患者的生存率可能有所改善.
方法：使用国家癌症数据库（NCDB），我们确定了6290例CMML患者，并收集了人口统计学数据，合并症,治疗,和生存。我们还进行了倾向匹配分析以控制基线差异。
结果：我们发现，与NAC患者相比，学术中心患者的中位总生存期（OS）（17.7个月比14.7个月）和5年OS（19.1%比15.3%）更高。此外,与接受NACs治疗的患者相比,在学术中心接受治疗的患者更有可能接受造血干细胞移植.学术和NAC之间的治疗开始时间总体相似。
结论：我们对最大的CMML患者可用数据集之一的研究支持在诊断时将CMML患者转诊至学术中心以优化这种罕见血液系统恶性肿瘤的结局的重要性。
方法：使用国家癌症数据库（NCDB），我们确定了6290例CMML患者，并收集了人口统计学数据，合并症,治疗,和生存。我们还进行了倾向匹配分析以控制基线差异。
结果：我们发现，与NAC患者相比，学术中心患者的中位总生存期（OS）（17.7个月比14.7个月）和5年OS（19.1%比15.3%）更高。此外,与接受NACs治疗的患者相比,在学术中心接受治疗的患者更有可能接受造血干细胞移植.学术和NAC之间的治疗开始时间总体相似。
结论：我们对最大的CMML患者可用数据集之一的研究支持在诊断时将CMML患者转诊至学术中心以优化这种罕见血液系统恶性肿瘤的结局的重要性。
