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Myelodysplastic syndrome

Blast-phase chronic myelomonocytic leukemia: more than just semantics

Leukemia volume 32, pages 2093–2094 (2018)Cite this article

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To the Editor,

We thank the author for her comment and appreciate her concerns on the need for uniformity with regards to the nomenclature of hematological neoplasms [1]. In our study, we present the largest to-date collection of patients with chronic myelomonocytic leukemia (CMML) who underwent leukemic blast transformation (n = 177) and provide a detailed insight into their clinical and laboratory characteristics and survival outcomes [2]. We agree that, currently by the World Health Organization (WHO) criteria, leukemic blast transformation in CMML (LT), as defined by the presence of ≥20% peripheral blood and/or bone marrow blasts, is classified as acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) [3]. That being said, AML-MRC currently includes LT from underlying myelodysplastic syndromes (MDS), MDS/myeloproliferative neoplasms, AML with MDS-related cytogenetic abnormalities, and AML with multilineage dysplasia (with the exception of de novo AML cases with mutated NPM1 or biallelic CEBPA mutations) [3]. This category also includes patients with 20–29% blasts with MRC who have a stable clinical course for ≥2 months (associated with favorable outcomes) and, importantly, excludes patients with prior exposure to cytotoxic agents or ionizing radiation therapy for unrelated diseases (therapy-related myeloid neoplasms) and recurrent cytogenetic abnormalities such as inversion 16 (CBFbeta-MYH11) and t(8;21) (RUNX1-RUNX1T1), respectively [3].

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References

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Acknowledgements

Current publication is supported in part by grants from the “The Gerstner Family Career Development Award” and the Mayo Clinic Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA. This publication was supported by CTSA Grant Number KL2 TR000136 from the National Center for Advancing Translational Science (NCATS).

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Authors and Affiliations

  1. Mayo Clinic, Rochester, MN, USA

    Mrinal M. Patnaik & Ayalew Tefferi

  2. MD Anderson Cancer Center, Houston, TX, USA

    Guillermo Garcia-Manero

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  1. Mrinal M. Patnaik
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  2. Ayalew Tefferi
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  3. Guillermo Garcia-Manero
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Correspondence to Mrinal M. Patnaik.

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Patnaik, M.M., Tefferi, A. & Garcia-Manero, G. Blast-phase chronic myelomonocytic leukemia: more than just semantics. Leukemia 32, 2093–2094 (2018). https://doi.org/10.1038/s41375-018-0228-4

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