The prognostic value of the interaction between ASXL1 and TET2 gene mutations in patients with chronic myelomonocytic leukemia: a meta-analysis

Purpose The prognostic role of TET2 and/or ASXL1 mutations which are common gene mutations in chronic myelomonocytic leukemia (CMML) remains controversial. Therefore, we conducted this meta-analysis to evaluate the prognostic efficacy of ASXL1 and TET2 mutations in CMML population. Methods PubMed, Cochrane and Embase for relevant research were employed to identify 16 studies. Overall survival rate (OS) with hazard ratios (HRs) was used for analysis, and each individual HR was applied to calculate the combined HR. Results The total HR of OS was 0.74, 95% CI = 0.61 - 0.91, P = 0.005, compared with CMML patients without TET2 mutations (TET2(MT)), and the total HR of OS was 1.56, 95% CI = 1.34 - 1.80, P = 0.000, compared with CMML patients without ASXL1 mutation (ASXL1(WT)), indicating that TET2(MT) and ASXL1(WT) were favorable for prognosis of CMML. According to whether the gene is mutated or not, the acute transformation rate of disease and mortality rate were further considered for assessment. Compared with the CMML patients with TET2(MT) and ASXL1(WT), the HR of patients with in both TET2(MT) and ASXL1(MT) was 1.51 (95% CI = 1.14 - 1.99; P = 0.004), the HR of patients with neither TET2(MT) nor ASXL1(MT) was 1.49 (95%CI = 1.12 - 1.98; P = 0.007), and the HR of TET2(WT) and ASXL1(MT) patients was 1.88 (95%CI = 1.21 - 2.94; P = 0.005). Conclusion Presence of TET2(MT) and ASXL1(WT) genotype was the most beneficial for the survival of CMML patients.