ARE BONE MARROW MONOCYTE CHARACTERISTICS AT DIAGNOSIS INDICATIVE OF THE EVOLUTION OF MYELODYSPLASTIC NEOPLASMS TO CHRONIC MYELOMONOCYTIC LEUKEMIA?
- 1Centro Infantil Boldrini, Campinas, SP, Brazil
- 2Centro de Hematologia e Hemoterapia (Hemocentro), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
- 3Departamento de Patologia, Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
Abstract
Background: The progression of myelodysplastic neoplasms (MDS) to chronic myelomonocytic leukemia (CMML) has been recognized since a long time. Several works have shown that 4.8% - 20% of patients with MDS may progress to CMML, depending on the criteria used to define CMML. As bone marrow (BM) immunophenotyping has been established as a useful ancillary method for the diagnosis of MDS, the question has been raised if some phenotypic characteristics of monocytes could predict this evolution in MDS patients. In a previous study of our group, analyzing the immunophenotypic features of BM in patients with MDS at diagnosis, 27% showed an increased percentage of monocytes compared to normal BM without peripheral monocytosis. This feature, together with increase of CD34+ myeloid progenitors and decrease of B-cell progenitors were associated with a poor outcome of the patients. Aim: Our aim was to analyze in a long-term follow-up of these patients, the progression to CMML. Methods: We examined patients of our Institution that were diagnosed between 2005 and 2012. Diagnosis was based on findings of peripheral blood cytopenias, BM cytology, cytogenetics and immunophenotyping with a 4-color flow cytometric protocol. Infinicyt 1.7 software was used for the analysis. WHO criteria were used for patients’ classification. Diagnosis of CMML was made when peripheral blood monocytes were persistently ≥ 1x109/l. Results: Among 95 cases, 26 that had total monocytes / total nucleated cells in BM immunophenotyping above the normal range (> 5.5% in controls). Among them, 6 (23%) progressed to CMML during their evolution: median 6,3 months (2-29). The median time of observation of all patients was 59 months. In May 2026 only 23 patients were still alive, and those who progressed to CMML were all dead. At diagnosis, patients progressing to CMML had a higher percentage of total monocytes / TNC (median 9.5%) but the percentage of CD16+monocytes among total monocytes was very variable and there was no statistical difference between both groups. Age and percentage of BM CD34+ myeloid cells were also not different in both groups. BM B-cell progenitors were absent at diagnosis in all cases developing CMML. Conclusion: Increase in BM monocytic lineage is frequent in MDS, although no monocytosis is detected in peripheral blood. However, it may be indicative of a progression to CMML. Our data also further confirm the existence of the entity oligomonocytic CMML recently included in the WHO and ICC classification. However, the evolution of MDS to full-blown CMML should be confirmed by molecular tests.
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BibTeX
@article{vidomarques2026bone,
title = {{ARE BONE MARROW MONOCYTE CHARACTERISTICS AT DIAGNOSIS INDICATIVE OF THE EVOLUTION OF MYELODYSPLASTIC NEOPLASMS TO CHRONIC MYELOMONOCYTIC LEUKEMIA?}},
author = {Joyce Rico VIDO-MARQUES and Suiellen Carvalho REIS-ALVES and Paula De Melo CAMPOS and Sara T O SAAD and Konradin Irene METZE and Irene Irene LORAND-METZE},
journal = {Hematology, Transfusion and Cell Therapy},
year = {2026},
month = oct,
doi = {10.1016/j.htct.2026.107416},
url = {https://doi.org/10.1016/j.htct.2026.107416},
note = {CC BY},
}
RIS
TY - JOUR
TI - ARE BONE MARROW MONOCYTE CHARACTERISTICS AT DIAGNOSIS INDICATIVE OF THE EVOLUTION OF MYELODYSPLASTIC NEOPLASMS TO CHRONIC MYELOMONOCYTIC LEUKEMIA?
AU - Joyce Rico VIDO-MARQUES
AU - Suiellen Carvalho REIS-ALVES
AU - Paula De Melo CAMPOS
AU - Sara T O SAAD
AU - Konradin Irene METZE
AU - Irene Irene LORAND-METZE
PY - 2026
DA - 2026/10/23
JO - Hematology, Transfusion and Cell Therapy
DO - 10.1016/j.htct.2026.107416
UR - https://doi.org/10.1016/j.htct.2026.107416
AB - Background: The progression of myelodysplastic neoplasms (MDS) to chronic myelomonocytic leukemia (CMML) has been recognized since a long time. Several works have shown that 4.8% - 20% of patients with MDS may progress to CMML, depending on the criteria used to define CMML. As bone marrow (BM) immunophenotyping has been established as a useful ancillary method for the diagnosis of MDS, the question has been raised if some phenotypic characteristics of monocytes could predict this evolution in MDS patients. In a previous study of our group, analyzing the immunophenotypic features of BM in patients with MDS at diagnosis, 27% showed an increased percentage of monocytes compared to normal BM without peripheral monocytosis. This feature, together with increase of CD34+ myeloid progenitors and decrease of B-cell progenitors were associated with a poor outcome of the patients. Aim: Our aim was to analyze in a long-term follow-up of these patients, the progression to CMML. Methods: We examined patients of our Institution that were diagnosed between 2005 and 2012. Diagnosis was based on findings of peripheral blood cytopenias, BM cytology, cytogenetics and immunophenotyping with a 4-color flow cytometric protocol. Infinicyt 1.7 software was used for the analysis. WHO criteria were used for patients’ classification. Diagnosis of CMML was made when peripheral blood monocytes were persistently ≥ 1x109/l. Results: Among 95 cases, 26 that had total monocytes / total nucleated cells in BM immunophenotyping above the normal range (> 5.5% in controls). Among them, 6 (23%) progressed to CMML during their evolution: median 6,3 months (2-29). The median time of observation of all patients was 59 months. In May 2026 only 23 patients were still alive, and those who progressed to CMML were all dead. At diagnosis, patients progressing to CMML had a higher percentage of total monocytes / TNC (median 9.5%) but the percentage of CD16+monocytes among total monocytes was very variable and there was no statistical difference between both groups. Age and percentage of BM CD34+ myeloid cells were also not different in both groups. BM B-cell progenitors were absent at diagnosis in all cases developing CMML. Conclusion: Increase in BM monocytic lineage is frequent in MDS, although no monocytosis is detected in peripheral blood. However, it may be indicative of a progression to CMML. Our data also further confirm the existence of the entity oligomonocytic CMML recently included in the WHO and ICC classification. However, the evolution of MDS to full-blown CMML should be confirmed by molecular tests.
SN - 2531-1379
SN - 2531-1387
ER -