%0 Journal Article
%T Therapy-related chronic myelomonocytic leukemia does not have the high-risk features of a therapy-related neoplasm.
%A Bataller A
%A Gener-Ricos G
%A Almanza-Huante E
%A Chien KS
%A Urrutia S
%A Bazinet A
%A Rodriguez-Sevilla JJ
%A Hammond D
%A Sasaki K
%A Takahashi K
%A DiNardo CD
%A Ravandi F
%A Borthakur G
%A Kadia TM
%A Kanagal-Shamanna R
%A Kantarjian HM
%A Garcia-Manero G
%A Montalban-Bravo G
%J Blood Adv
%V 8
%N 11
%D 2024 Jun 11
%M 38513082
%F 7.637
%R 10.1182/bloodadvances.2024012565
%X <B>UNASSIGNED: </B>Therapy-related myeloid neoplasms (t-MNs) arise after exposure to cytotoxic therapies and are associated with high-risk genetic features and poor outcomes. We analyzed a cohort of patients with therapy-related chronic myelomonocytic leukemia (tCMML; n = 71) and compared its features to that of de novo CMML (dnCMML; n = 461). Median time from cytotoxic therapy to tCMML diagnosis was 6.5 years. Compared with dnCMML, chromosome-7 abnormalities (4% vs 13%; P = .005) but not complex karyotype (3% vs 7%; P = .15), were more frequent in tCMML. tCMML was characterized by higher TP53 mutation frequency (4% vs 12%; P = .04) and lower NRAS (6% vs 22%, P = .007) and CBL (4% vs 12%, P = .04) mutation frequency. Prior therapy with antimetabolites (odd ratio [OR], 1.22; 95% confidence interval [CI], 1.05-1.42; P = .01) and mitotic inhibitors (OR, 1.24; 95% CI, 1.06-1.44; P = .009) was associated with NF1 and SETBP1 mutations whereas prior mitotic inhibitor therapy was associated with lower TET2 mutation frequency (OR, 0.71; 95% CI, 0.55-0.92; P = .01). Although no differences in median overall survival (OS) were observed among tCMML and dnCMML (34.7 months vs 35.9 months, P = .26), multivariate analysis for OS revealed that prior chemotherapy was associated with increased risk of death (hazard ratio, 1.76; 95% CI, 1.07-2.89; P = .026). Compared with a cohort of therapy-related myelodysplastic syndrome, tCMML had lower TP53 mutation frequency (12% vs 44.4%, P < .001) and less unfavorable outcomes. In summary, tCMML does not exhibit the high-risk features and poor outcomes of t-MNs.