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Chronic Myelomonocytic Leukemia

Diagnosis
Patients with CMML may present with a wide variety of symptoms, including:1
  • Fever, fatigue, night sweats, and weight loss
  • Infection
  • Bleeding caused by thrombocytopenia
  • Hepatomegaly (in some patients)
  • Splenomegaly (in some patients)
In patients whose white blood cell (WBC) counts are normal or slightly decreased, the clinical features of CMML may be identical to those with myelodysplastic syndromes.1 In patients with elevated WBC counts, the clinical features of CMML are more like those of chronic myeloproliferative disorders, including more frequent splenomegaly and hepatomegaly.

WHO Criteria for a Diagnosis of CMML2,3
  • Persistent peripheral blood monocytosis >1 x 109/L

  • No Philadelphia chromosome or Bcr-Abl fusion gene

  • <20% blasts* in the blood or bone marrow

  • Dysplasia in ≥1 myeloid lineage
      • If myelodysplasia is absent or minimal, the diagnosis of CMML may still be made if the other requirements are present and either of the following applies:
      • Acquired, clonal cytogenetic abnormality is present in marrow cells
      • Monocytosis has persisted for ≥3 months, and all other causes of monocytosis have been excluded

  • CMML-1:
      • Blasts <5% in blood and <10% in bone marrow

  • CMML-2:
      • Blasts are 5% to 19% in blood, or
      • Blasts are 10% to 19% in marrow, or
      • Auer rods are present and blasts are <20% in blood or marrow

  • CMML-1 or CMML-2 with eosinophilia:
      • Above criteria are present and
      • Eosinophil count in the peripheral blood is >1.5 x 109/L
* In this classification of chronic myelomonocytic leukemia, blasts include myeloblasts, monoblasts, and promonocytes.


References:
  1. National Cancer Institute. Myelodysplastic/Myeloproliferative Diseases (PDQ®): Treatment. Health Professional Version. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/mds-mpd/healthprofessional/allpages. Accessed April 24, 2006.
  2. Vardiman JW, Harris NL, Brunning RD. The World Health Organization (WHO) classification of the myeloid neoplasms. Blood. 2002;100:2292-2302.
  3. Cortes J. CMML: a biologically distinct myeloproliferative disease. Curr Hematol Rep. 2003;2:202-208.
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