Kriteria Diagnosis Morfologi untuk Chronic Myelomonocytic Leukemia (CMML)

Kriteria Diagnostik Komprehensif

The World Health Organization (WHO) recommends that a diagnosis of CMML requires persistent monocytes in the peripheral blood (>1×10^9/L), dysplasia in one or more myeloid cell lines, <20% blasts in the peripheral blood and bone marrow, no Philadelphia chromosome or BCR-ABL1 gene fusion, and no PDGFRA or PDGFRB rearrangement 1, 2, 3
The WHO classification requires the absence of the Philadelphia chromosome or BCR-ABL1 gene fusion, and the absence of PDGFRA or PDGFRB rearrangement 2, 3
The diagnosis of CMML also requires less than 20% blasts in the peripheral blood and bone marrow, including myeloblasts, monoblasts, and promonocytes 2, 3
A minimum of one of the following criteria is required: dysplasia in one or more myeloid cell lines, clonal cytogenetic or molecular genetic abnormalities in hematopoietic cells, or persistent monocytes for at least 3 months without evidence of other causes of monocytosis 2, 3

The 2016 classification divides CMML into three groups based on the number of blasts: CMML-0 (<2% blasts in peripheral blood and <5% blasts in bone marrow), CMML-1 (2-4% blasts in peripheral blood and/or 5-9% blasts in bone marrow), and CMML-2 (5-19% blasts in peripheral blood, 10-19% blasts in bone marrow, and/or presence of Auer rods) 4, 5

CMML can be divided into two subtypes based on clinical characteristics: myelodysplastic-type CMML (MD-CMML) with a leukocyte count <13×10^9/L, and myeloproliferative-type CMML (MP-CMML) with a leukocyte count ≥13×10^9/L 6, 4

The diagnosis of CMML requires the examination of peripheral blood, bone marrow aspirate, and bone marrow biopsy, including the assessment of monocyte count, dysplasia, and blast percentage 1, 7, 8
Cytogenetic and molecular analysis are also necessary to exclude clonal abnormalities and to identify specific genetic mutations 7, 8

It is essential to exclude reactive monocytosis caused by infection or solid tumors 1, 7
CMML with eosinophilia and PDGFRA or PDGFRB rearrangement is classified as a separate entity in the WHO 2008 classification 6
The diagnosis of CMML requires careful evaluation and monitoring of monocyte counts and other diagnostic criteria to ensure accurate diagnosis and treatment 2, 3