Making Sense of Prognostic Models in Chronic Myelomonocytic Leukemia

To evaluate established prognostic models in chronic myelomonocytic leukemia (CMML) and describe the challenges associated with their application in clinical practice.

CMML is a clonal hematopoietic stem cell disorder with heterogeneous clinical and molecular features. Outcomes of CMML patients can vary from indolent disease with expected survival measured in years versus proliferative subtypes with rapid progression to acute myeloid leukemia and survival measured in months. Several prognostic scoring systems have been developed to risk stratify CMML patients. While all these models are valid, they demonstrate significant predictive heterogeneity. Significant intra-patient (applying different models in the same patient giving rise to different prognostic results) and intra-model (patients in a similar prognostic group by a given model can be reclassified to different risk groups by other models) heterogeneities exist when applying current CMML prognostic models in the clinic. A personalized prediction approach may open new opportunities in risk stratifying patients with CMML and other myeloid malignancies.