CMML

Question 1

Defining lab feature

Answer 1

absolute monocytosis for >3 months

Question 2

CMML classification

Answer 2

overlap syndrome between MDS and MPN (Shared features of both)

Question 3

what are the hypomethylating agents?

Answer 3

azacitidine or decitabine

Question 4

Clinical behavior

Answer 4

• among most aggressive chronic leukemias with a propensity to progress to AML

Question 5

CMML patients are at risk for transformation to what + frequency of progression?

Answer 5

• AML
• 15-30 percent

Question 6

Staging depends on

Answer 6

Percentage of blasts in peripheral blood and bone marrow

Question 7

Management of higher risk CMML

Answer 7

IF medically fit, HSCT
IF not a transplant candidate, HMA or hydrea

Question 8

Management of lower risk

Answer 8

Given asymptomatic and no indication for treatment, plan for active surveillance
Indications for treatment:
Constitutional/systemic symptoms (eg, fever, weight loss)
Organ involvement (eg, symptomatic splenomegaly, skin disease, renal dysfunction, pulmonary involvement)
Alterations in blood counts (eg, worsening cytopenias, increasing blast percentage, hyperleukocytosis, leukostasis)
Given indication for treatment, plan for HMA vs. hydrea

Question 9

Monocyte threshold for CMML diagnosis

Answer 9

1000 monocytes/microliter

Question 10

Monocyte threshold for CMML diagnosis if a mutation is present

Answer 10

500 monocytes/microliter

Question 11

Most common CMML mutations

Answer 11

TET2
SRSF2
CBL