Gurung Shekhar, Karki Saurab, Khadka Manoj, Bhatta Bhuwan, Adhikari Ayush, Shrestha Amar N
Chhatrapati Free Health Clinic.
Military Hospital, Itahari.
Ann Med Surg (Lond). 2023 Feb 7;85(2):257-260. doi: 10.1097/MS9.0000000000000198. eCollection 2023 Feb.
Chronic myelomonocytic leukemia (CMML) is a rare disease of clonal hematopoietic stem cells with an inherent risk of leukemic transformation, seen in an elderly male.
Herein, the authors report a case of CMML in a 72-year-old male who presented with fever and abdominal pain for 2 days with a history of easy fatigability. Examination revealed pallor and palpable supraclavicular nodes. Investigations showed leukocytosis with a monocyte count of 22% of white blood cell count, 17% blast cells in bone marrow aspiration, increased blast/promonocytes, and positive markers in immunophenotyping. The patient is planned for injection of azacitidine, 7 days cycle for a total of six cycles.
CMML is classified as overlapping myelodysplastic/myeloproliferative neoplasms. It can be diagnosed based on a peripheral blood smear, bone marrow aspiration and biopsy, chromosomal analysis, and genetic tests. The commonly used treatment options are hypomethylating agents like azacitidine and decitabine, allogeneic hematopoietic stem cell transplant, and cytoreductive agents like hydroxyurea.
Despite various treatment options, the treatment is still unsatisfactory, demanding standard management strategies.
慢性粒单核细胞白血病（CMML）是一种克隆性造血干细胞的罕见疾病，具有白血病转化的内在风险，多见于老年男性。
在此，作者报告一例72岁男性CMML病例，该患者有2天发热和腹痛病史，伴有易疲劳史。检查发现面色苍白和可触及的锁骨上淋巴结。检查显示白细胞增多，单核细胞计数占白细胞计数的22%，骨髓穿刺中有17%的原始细胞，原始细胞/早幼单核细胞增加，免疫表型分析中有阳性标志物。该患者计划注射阿扎胞苷，7天一个周期，共六个周期。
CMML被归类为骨髓增生异常/骨髓增殖性肿瘤重叠综合征。它可以通过外周血涂片、骨髓穿刺和活检、染色体分析以及基因检测来诊断。常用的治疗选择是阿扎胞苷和地西他滨等去甲基化药物、异基因造血干细胞移植以及羟基脲等细胞减灭剂。
尽管有多种治疗选择，但治疗仍不尽人意，需要标准的管理策略。
