Models of Prognostication in Chronic Myelomonocytic Leukemia

PURPOSE OF REVIEW: Within the group of the myelodysplastic/myeloproliferative overlap neoplasms of the adult age, chronic myelomonocytic leukemia (CMML) is characterized by an extremely variable clinical course. This review aims to cover over the years main advancements in the identification of CMML clinical and biological features associated to survival outcomes and the consequent development of prognostic tools for individual patient treatment decision making. RECENT FINDINGS: According to the last WHO classification of myeloid neoplasms, three subgroups of patients may be recognized on the base of percentage of blasts in marrow and in peripheral blood (CMML-0, CMML-1, and CMML-2), with corresponding decreasing life-expectations. Nonetheless, in each of the subgroups, prominent disparateness of biological characteristics associates to a large heterogeneity of clinical presentation, with very different prognostic implications. Recent findings indicate that the integration of clinical and molecular data appears to provide the most helpful prognostic information. Together with an orderly enlightenment for the increasing conception of specific disease characteristics, this review offers a comprehensive and thoughtful summary of the prognostic models developed over the last three decades for CMML.