Chronic Myelomonocytic Leukemia: Focus on Clinical Practice Mrinal M. Patnaik, MD, Ayalew Tefferi, MD  Mayo Clinic Proceedings  Volume 91, Issue 2, Pages 259-272 (February 2016) DOI: 10.1016/j.mayocp.2015.11.011 Copyright © 2016 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 Diagnostic algorithm for peripheral blood (PB) monocytosis. BM = bone marrow; CML = chronic myeloid leukemia; CMML = chronic myelomonocytic leukemia; FISH = fluorescence in situ hybridization; JMML = juvenile myelomonocytic leukemia; MDS = myelodysplastic syndrome; MPN = myeloproliferative neoplasm; RARS-T = refractory anemia with ringed sideroblasts associated with marked thrombocytosis; U = unclassifiable. Mayo Clinic Proceedings 2016 91, 259-272DOI: (10.1016/j.mayocp.2015.11.011) Copyright © 2016 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 Peripheral blood and bone marrow findings in chronic myelomonocytic leukemia. A, Peripheral blood smear showing promonocyte (arrow) with mature but atypical increased peripheral blood monocytes (Wright-Giemsa, original magnification ×400). B, Bone marrow aspirate showing granulocytic/monocytic hyperplasia with occasional promonocytes (arrow) (Wright-Giemsa, original magnification ×400). C, Core-needle biopsy specimen showing markedly hypercellular bone marrow with granulocytic hyperplasia (hematoxylin-eosin, original magnification ×100). D, Bone marrow chloroacetate and butyrate esterase cytochemical stains reveal an increase in dual esterase–positive cells (arrow) (original magnification ×400). Mayo Clinic Proceedings 2016 91, 259-272DOI: (10.1016/j.mayocp.2015.11.011) Copyright © 2016 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 3 Contemporary molecularly integrated risk stratification of 420 patients with World Health Organization–defined chronic myelomonocytic leukemia (CMML) using (A) the Molecular Mayo Model (MMM) and (B) the Groupe Français des Myélodysplasies (GFM) CMML prognostic model. Mayo Clinic Proceedings 2016 91, 259-272DOI: (10.1016/j.mayocp.2015.11.011) Copyright © 2016 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 4 Mayo Clinic risk-adapted algorithm for the management of patients with chronic myelomonocytic leukemia (CMML). ESA = erythropoiesis-stimulating agent; HSCT = hematopoietic stem cell transplant; MDS = myelodysplastic syndrome; MPN = myeloproliferative neoplasm. Mayo Clinic Proceedings 2016 91, 259-272DOI: (10.1016/j.mayocp.2015.11.011) Copyright © 2016 Mayo Foundation for Medical Education and Research Terms and Conditions