The clinical management of chronic myelomonocytic leukemia

Chronic myelomonocytic leukemia (CMML) is an aggressive malignancy characterized by peripheral monocytosis and ineffective hematopoiesis. It has been historically classified as a subtype of the myelodysplastic syndromes (MDSs) but was recently demonstrated to be a distinct entity with a distinct natural history. Nonetheless, clinical practice guidelines for CMML have been inferred from studies designed for MDSs. It is imperative that clinicians understand which elements of MDS clinical practice are translatable to CMML, including which evidence has been generated from CMML-specific studies and which has not. This allows for an evidence-based approach to the treatment of CMML and identifies knowledge gaps in need of further study in a disease-specific manner. This review discusses the diagnosis, prognosis, and treatment of CMML, with the task of divorcing aspects of MDS practice that have not been demonstrated to be applicable to CMML and merging those that have been shown to be clinically similar.