Moderate anemia at diagnosis is an independent prognostic marker of the EUTOS, Sokal and Hasford scores for survival and treatment response in chronic-phase, chronic myeloid leukemia patients with frontline imatinib

Objectives: We aimed to examine the prognostic value of anemia for the diagnosis of chronic myeloid leukemia in the chronic phase (CML-CP) receiving imatinib. Methods: One hundred fifty-four CML-CP patients were enrolled. The influences of moderate anemia with hemoglobin (Hb) < 10 g/dl, four scoring systems and the early molecular response at three months (BCR-ABL ≤ 10%; 3M-EMR) on the achievement of a deep molecular response (DMR, MR4.5), progression-free survival (PFS), event-free survival (EFS) and overall survival (OS) were compared. Results: Moderate anemia was identified in 44 (28.6%) patients. These patients had more aggressive baseline features and higher risks, as assessed by scoring systems, and less favorable treatment responses vs. those without anemia, including 3M-EMR (50.0% vs. 69.1%), a complete cytogenetic response at six months (20.5% vs. 50.9%), and a major molecular response at 12 months (22.5% vs. 45.2%) with a median follow-up of 54.0 months. Furthermore, an Hb of 10 g/dl better distinguished DMR, EFS, PFS and OS than the EUTOS, Sokal and Hasford scores and better predicted the responses and survivals in combination with 3M-EMR than 3M-EMR alone. Conclusions: This finding highlights the significance of anemia in CML-CP and suggests that patients with anemia at diagnosis should be carefully monitored and might benefit from more potent TKIs if not achieving 3M-EMR.