ABSTRACT Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic stem cell malignancy and the only curable therapy is allogeneic hematopoietic stem cell transplantation (allo-HSCT).

However, allo-HSCT is not appropriate for all CMML patients, and relapse is the leading cause of treatment failure. This project conducted a nationwide multicenter real-world study to

develop a novel prediction scoring system for early relapse. A total of 238 CMML patients from twenty-seven medical centers treated with allo-HSCT, and 307 adult patients with CMML who

underwent allo-HSCT in a publicly available research dataset from the Center for International Blood and Marrow Transplantation Registry (CIBMTR) database were included. Independent

3.425; _P_ = 0.017). A risk-grading scoring system was developed based on the regression coefficients and patients were stratified into low-risk (0–1 point), intermediate-risk (1.5–2 points)

and high-risk ( > 2 points) groups. The validated internal c-statistic was 0.767 (95% confidence interval [CI], 0.674–0.860), and the external c-statistic was 0.769 (95% CI,

0.703–0.836). In the derivation cohort, the cumulative incidence rates of early relapse in the low-risk, intermediate-risk, and high-risk groups were 1.35% (95% CI: 1–4%), 10.40% (95% CI:

4–16%), and 29.54% (95% CI: 16–39%) (_P_ < 0.001), respectively. This scoring system can be utilized to early identification of patients at a high risk of relapse and contributing to the

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MYELOID LEUKEMIA PATIENTS UNDERGOING ALLOGENEIC HEMATOPOIETIC STEM-CELL TRANSPLANTATION Article 18 April 2023 DATA AVAILABILITY The data are not publicly available due to their containing

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was supported by the National Key Research and Development Program of China (No. 2021YFC2500304), the Key Program of National Natural Science Foundation of China (No. 82230004), National

Natural Science of Foundation of China (No. 81970113) and Capital Health Research and Development of Special (No. 2022-1-4082). AUTHOR INFORMATION Author notes * These authors contributed

equally: Jian-Ying Zhou, Yu-Xiu Chen. AUTHORS AND AFFILIATIONS * Peking University People’s Hospital, Peking University Institute of Hematology, National Clinical Research Center for

Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China Jian-Ying Zhou, Yu-Xiu Chen, Yu-Hong Chen, Feng-Rong Wang, Yuan-Yuan Zhang, Xiao-Dong

Mo, Wei Han, Jing-Zhi Wang, Yu Wang, Huan Chen, Xiang-Yu Zhao, Ying-Jun Chang, Kai-Yan Liu, Xiao-Jun Huang & Xiao-Hui Zhang * Department of Hematology, The First Affiliated Hospital of

Xinjiang Medical University, Urumqi, China Hai-Long Yuan & Ming Jiang * Department of Hematology, Xiangya Hospital of Central South University, Changsha, China Ya-Jing Xu * Department of

Hematology, Sichuan Academy of Medical Sciences, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China Xiao-Bing Huang * Hematology

section, Cancer Center, The First Hospital of Jilin University, Changchun, China Su-Jun Gao * Department of Hematology, Tongji Hospital of Tongji Medical College of Huazhong University of

Science and Technology, Wuhan, China Yi-Cheng Zhang * Hematology Department, The 960th Hospital of The People’s Liberation Army (PLA) Joint Logistics Support Force, Jinan, China Fang Zhou *

Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China Xian-Min Song * Department of Hematology, Bone Marrow Transplant

Center, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China Yi Luo * Department of Hematology, Changhai Hospital, The Naval Medical University, Shanghai,

China Jian-Min Yang * Department of Hematology, Zhujiang Hospital of Southern Medical University, Guangzhou, China Yu-Hua Li * Department of Hematology, Guangzhou First People’s Hospital,

School of Medicine, South China University of Technology, Guangzhou, China Shun-Qing Wang * Department of Hematology, Peking University First Hospital, Beijing, China Yu-Jun Dong * Xinqiao

Hospital, The Third Military Medical University, Chongqing, China Xi Zhang & Yi-Mei Feng * Department of Hematology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical

Sciences, Guangzhou, China Xin Du * Department of Hematology, Jiangsu Province Hospital, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China Han Zhu * Department of

Hematology, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou, China Zun-Min Zhu * Department of Hematology, School of First Affiliated Hospital of

Shandong First Medical University, Shandong Province Qianfoshan Hospital, Jinan, China Ke-Hong Bi * Department of Hematology, West China Hospital, Sichuan University, Chengdu, China Ting Niu

* Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China Ding-Ming Wan * Department of Hematology, The First Affiliated Hospital of Wenzhou

Medical University, Wenzhou, China Yi Chen * Department of Hematology, The Second Affiliated Hospital (Tangdu Hospital) of Air Force Medical University, Xi’an, China Li Liu * Department of

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inPubMed Google Scholar CONTRIBUTIONS JYZ and XHZ contributed to the study design. JYZ, YXC, HLY, YJX, XBH, SJG, YCZ, FZ, XMS, YL, JMY, YHL, SQW, YJD, XZ, YMF, XD, HZ, ZMZ, KHB, MJ, TN, DMW,

YC, LL and HY collected the data. JYZ, YXC, YHC, FRW, YYZ, and XDM performed data analysis. JYZ drafted and wrote the manuscript. WH, JZW, YW, HC, XYZ, YJC, KYL and XJH revised it

critically. XHZ conceived and directed the study and revised the manuscript. The final version of the manuscript was critically reviewed and approved by all authors. CORRESPONDING AUTHOR

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Chen, YX., Yuan, HL. _et al._ A multifactorial risk scoring system for the prediction of early relapse in CMML patients with allo-HSCT: a nationwide representative multicenter study. _Bone

Marrow Transplant_ 60, 310–318 (2025). https://doi.org/10.1038/s41409-024-02480-3 Download citation * Received: 06 July 2024 * Revised: 06 November 2024 * Accepted: 12 November 2024 *

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