New guidance on the management of chronic myelomonocytic leukaemia


  • Dawn O'Shea
  • Univadis Medical News
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The European research network, LeukemiaNet, and the European Hematology Association (EHA) have published new recommendations on the management of chronic myelomonocytic leukaemia (CMML).

The guidance, formulated by a panel of European and US experts, provides recommendations for the standardised diagnosis, prognosis and choice of treatment for adult patients with CMML.

In relation to diagnosis, the guidance recommends mandatory cytogenetic analysis of at least 20 mitoses.

For risk assessment, the Groupe Français des Myélodysplasies, CMML‐specific prognostic scoring system (CPSS) or the Mayo Molecular models are recommended. If mutational profiling is not available, CMML-specific scores including the CPSS or MD Anderson Prognostic Score (MDAPS) are recommended.

The guidance details 10 recommendations in relation to treatment, addressing indications for intensive induction chemotherapy, hypomethylating agents before transplant and hydroxyurea, as well as guidance on the management of anaemia.

Reflecting the limitations of the available research, the recommendations are based mainly on expert consensus rather than on high-quality evidence.

Hence, the expert panel has called for steps to improve the quality of evidence supporting clinical recommendations for CMML. Inclusion of CMML patients in clinical trials is strongly encouraged at all stages of the disease. It is expected that recently established international collaborative networks will clarify the management of CMML in the coming years.

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