Low initial hemoglobin and high-risk additional chromosomal abnormalities predict poor long-term survival in chronic phase chronic myeloid leukemia

Predicting prognosis using baseline clinical and genetic features remains critical in the tyrosine-kinase-inhibitor (TKI) era of chronic myeloid leukemia (CML). We retrospectively analyzed 944 chronic phase CML (CML-CP) patients treated at a single center in China, aiming to clarify treatment responses, long-term outcomes and baseline prognostic factors in real-world settings. Analyses were performed in available patient subsets depending on endpoint-specific data completeness. The study found that female patients had higher major molecular response (MMR) than males (P = 0.004). Age ≥ 45 years was associated with lower complete cytogenetic response (CCyR; p = 0.006), overall survival (OS; p = 0.011), and CML-related survival (p = 0.010). Initial white-blood-cell counts ≥ 118 × 10⁹/L predicted inferior CCyR and MMR (both P < 0.001). Conversely, baseline haemoglobin ≥ 110 g/L independently predicted superior CCyR, MMR (both P < 0.001), event-free survival (EFS; p = 0.009), progression-free survival (PFS; p = 0.008), OS (P = 0.001), and CML-related survival (p = 0.001). Compared to patients without ACAs, high-risk additional chromosomal abnormalities (HR-ACAs) conferred worse EFS (P = 0.042), PFS (P = 0.057), OS (P = 0.010) and CML-related survival (P = 0.006). Gender and initial WBC primarily influenced TKI treatment responses, while age and initial Hgb levels influenced both TKI responses and long-term survival. Additionally, HR-ACAs significantly predicted poorer long-term survival in CML-CP patients.