Chronic Myelomonocytic Leukemia

The inclusion of CMML into MDS was long debated. It has been recognized that CMML has both myelodysplastic and myeloproliferative features. Patients with myelodysplastic features present with low or normal leukocyte count, multilineage dysplasia, no organomegaly, but with peripheral monocytosis. Bone marrow morphology resembles MDS/RA or MDS/RAEB with monocytosis. However, patients with myeloproliferative features have marked leukocytosis, monocytosis, organomegaly, and skin infiltrations. Whether dysplastic or proliferative CMML represents a different phase of a single disease or are distinct entities remains unclear. The FAB criteria for the diagnosis of CMML is the presence of peripheral absolute monocytosis higher than 1 X 109/L. Peripheral blood and bone marrow smears show trilineage dysplasia and monocytosis associated with blast cells (Plate 14-27).

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