Analysis of Clinical Characterization of CMML.
Authors: Wu Suijing , Du Xin , Lin Wei , Huang Zilun , Weng Jianyu , Huang Zhixin , Zhou Maohua , Su Jianhua , Lu Zesheng 
Published: October 2019

Abstract
Abstract 4853
Chronic myelomonocytic leukemia(CMML) was incorporated into the FBA classification of myelodysplastic syndromes(MDS) because dysplastic changes are commonly found in blood and bone marrow cells of patients with this order. However, sometimes doctors misdiagnose it because it may be distinguishable by only the presence of monocytosis(>1.0×109/L) in the blood.CMML is always a rather controversial type of MDS, some of patients present charaterication of myeloproliferation. In a further step, the WHO classification now includes CMML in a category of mixed myeloproliferative/myelodysplastic disorders, together with atypical CML and JMML,and proposed to separate CMML into CMML I and CMML II [Harris et al. Journal of Clinical Oncology,1999; Bennett International Journal of Hematology,2000]. Prognosis is also extremely variable in CMML.The median survival was about 19 months in 288 CMML patients included in Düsseldorf MDS Registry. There was no significant difference in median survival of MPD-CMML and MDS-CMML[Nosstinger et al. Leukemia Researsh.2001]. Germing reported the median of CMML patients who developed AML(18%) was 14 months,as compared to 20 months for patients who did not develop AML. [Germing et al. Leukemia and Lymphoma. 2004].In 2002, the M.D.Anderson Prognostic Score(MDAPS) using lymphocyte counts, hemoglobin level, medullary blast count, and presence of immature myeloid precursors in blood was developed by Onida[Onida et al. Blood. 2002]. Here we analyzed the clinical characterization of CMML in our hospital. 16 cases of CMML diagnosed according to the criteria of WHO classification were retrospectively analyzed. The median age was 51 years,and female/male was 11/5.Most of patients were median or older men with splenomegaly(37%), figure(30%), bone pain(25%), hepatomegaly(13%). White blood counts varyied from hypoleukocytosis to normal to hyperleukocytosis, median count was 27×109/L (1.3-74×109/L), median platelet count was 97×109/L(12-576×109/L),median hemoglobin count was 91g/l(62-138 g/l), median monocyte count was 4.6×109/L(2-14.5×109/L), median lymphocyte count was 4.4×109/L(1.0-33.8×109/L), LDH was elevated. Bone marrow was obviously active with dyshaematopoiesis, median blast cells of granulocyte were 8.5%(1%-18%), immature monocyte was 0-2.5%. 44% of patients had eosinophilic cells and/or basophil cells increase in bone marrow, and decrease in NAP, median score was 13(0-62). Immunophenotypic feature was CD13+CD14+CD56+,and FISH: BCR-ABL(-).The clinical course of CMML could remain stable for many years only low dose chemotherapy or without any treatment. On the other hand, there were patients with rapidly progressive disease. The Median survival was 20 months. CMML-I cases average survival was 50+ months, CMML-II was 18+ months≤ MDAPS showed low risk group had a average survival of 60+ months, intermediate group 1 and 2 was 30+ months and 17+ months,high risk patients with a average survival of only 1+ months. Only one case transformed into M4 as late as 3+ years after diagnosis of CMML(6%).
In conclusion, the new criteria of WHO classification presents clinical feature of CMML better, and it can provide more effective prognostic parameters for risk assessment with MDAPS.

Disclosures
No relevant conflicts of interest to declare.