Chronische myelomonocytaire leukemie als toevallige vondst op de dienst geriatrie

Chronic myelomonocytic leukemia as an incidental finding at the geriatric department Persistent monocytosis may indicate a hematologic malignancy and merits a hematologic work-up. Chronic myelomonocytic leukemia (CMML) is a rare, but malignant disorder of the hematopoietic stem cell with an annual incidence of 1-2 persons per 100,000. The real incidence is probably higher because of underdiagnosis. The median age at the diagnosis is 65 to 75 years. The diagnosis is made based on the clinical symptoms, a peripheral blood analysis, a bone marrow aspirate and biopsy, as well as cytogenetic and molecular studies. The symptomatology is non-specific, but can be classified into a group with myelodysplastic (fatigue, anemia, infections) and a group with myeloproliferative (B-symptoms, hepatosplenomegaly) features. In the peripheral blood, by definition, one measures ≥ 0,5 x 109/l of monocytes, which account for more than 10% of the white blood cell differentiation. The bone marrow is often hypercellular with the presence of dysplasia. In 20% to 30% of the cases, cytogenetic abnormalities can be found, i.e. abnormalities in the karyotype. In the vast majority (90%), somatic mutations are present. The prognosis of patients with CMML is reserved with a median survival of about 3 years. One in 3 progresses to acute myeloid leukemia. The therapeutic options for CMML are limited. The only possible curative treatment is an allogeneic stem cell transplantation. The other options are primarily supportive and intended as symptom control.