Diagnosis and Management of Hypergranular Monocytes
Diagnostic Approach
- The European Hematology Association recommends that the diagnosis of chronic myelomonocytic leukemia (CMML) be based on persistent monocytosis (>1×10⁹/L) in peripheral blood with dysplasia in one or more cellular lines 1, 2
- The American Society of Hematology suggests that the diagnosis of acute promyelocytic leukemia (APL) be based on the presence of hypergranular cells and high risk of hemorrhage 3
- Infections, autoimmune diseases, and solid tumors can cause non-neoplastic hypergranular monocytes 1, 2, 4, 5
Diagnostic Criteria
- The World Health Organization recommends that the diagnosis of CMML be based on the presence of monocytosis, dysplasia, and exclusion of other causes of monocytosis 1, 2
- The International Society for Laboratory Hematology suggests that the diagnosis of APL be based on the presence of hypergranular cells, high risk of hemorrhage, and exclusion of other causes of hypergranular cells 3
Treatment Approach
- The National Comprehensive Cancer Network recommends that patients with CMML be treated with hypomethylating agents, chemotherapy, or hematopoietic stem cell transplantation based on risk stratification 1, 2, 3
- The American Society of Hematology suggests that patients with APL be treated with all-trans retinoic acid (ATRA) and chemotherapy 3
- Patients with non-neoplastic hypergranular monocytes should be treated based on the underlying cause, such as antibiotics for infections or immunosuppressants for autoimmune diseases 1, 2, 4, 5, 7