{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T07:21:57Z","timestamp":1783408917371,"version":"3.54.6"},"reference-count":43,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HemaSphere"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Chronic myelomonocytic leukemia (CMML) shows marked prognostic heterogeneity. Although leukocytosis is a recognized adverse prognostic factor, the contribution of its individual components remains insufficiently defined. In a cohort of 240 patients classified according to International Consensus Classification (ICC) and World Health Organization (WHO) 2022 criteria\u2014including 23% with oligomonocytic CMML\u2014we evaluated the prognostic impact of neutrophil and monocyte percentage, along with surrogate markers of their relative increase, including relative lymphopenia (&lt;20%) and elevated monocyte\u2010to\u2010lymphocyte ratio (MLR\u2009&gt;\u20091). Both relative lymphopenia and MLR\u2009&gt;\u20091 emerged as independent adverse prognostic factors, correlating with adverse mutations (\n                    <jats:italic>TP53<\/jats:italic>\n                    , RAS pathway) and high\u2010risk clinical features. Notably, MLR\u2009&gt;\u20091 identified a subset of patients with dysplastic CMML with molecular and clinical profiles resembling proliferative CMML (MP\u2010CMML). These variables retained their prognostic impact after adjustment for established prognostic models (CMML\u2010specific prognostic scoring system [CPSS], CPSS with the addition of the variable platelet\u2009&lt;\u2009100\u2009\u00d7\u200910\u2079\/L [CPSS\u2010P], and Mayo prognostic model), and their addition improved predictive performance. Based on these and other objective variables readily available from a routine complete blood count (CBC), we developed the objective prognostic index for CMML (OPIC), which integrates hemoglobin\u2009&lt;\u200911\u2009g\/dL, platelets\u2009&lt;\u2009100\u2009\u00d7\u200910\u2079\/L, MP\u2010CMML, and MLR\u2009&gt;\u20091. OPIC stratified patients into four risk categories with distinct survival outcomes (median overall survival [OS]: 104, 66.6, 34.3, and 18.3 months), demonstrating strong discriminatory power. Variable selection was performed using stepwise and elastic net regression, and random survival forests. Model performance metrics, including the C\u2010index, time\u2010dependent area under the receiver operating characteristic curve, and the Brier Score, were internally validated using bootstrapping\u2010based resampling methods and externally validated in a cohort of 250 patients. OPIC provides a robust, accessible tool for CMML risk stratification, supporting its integration into routine clinical workflows and early therapeutic decision\u2010making.\n                  <\/jats:p>","DOI":"10.1002\/hem3.70286","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T13:09:17Z","timestamp":1769605757000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Unveiling relative lymphopenia and elevated monocyte\u2010to\u2010lymphocyte count as novel independent adverse prognostic factors in chronic myelomonocytic leukemia (CMML)\u2014Proposal of the objective prognostic index for CMML (OPIC)"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7934-9130","authenticated-orcid":false,"given":"Xavier","family":"Calvo","sequence":"first","affiliation":[{"name":"Laboratori de Citologia Hematologica Servei de Patologia, Grup de Recerca Translacional en Neoplasies Hematologiques (GRETNHE), Hospital del Mar Research Institute Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abora","family":"Rial\u2010Villavecchia","sequence":"additional","affiliation":[{"name":"Servei de Medicina Interna, Hospital del Mar, Programa de doctorat de Medicina i Recerca Translacional Universitat de Barcelona (UB)  Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Roman\u2010Bravo","sequence":"additional","affiliation":[{"name":"Laboratori de Citologia Hematologica Servei de Patologia, Grup de Recerca Translacional en Neoplasies Hematologiques (GRETNHE), Hospital del Mar Research Institute Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Garcia\u2010Avila","sequence":"additional","affiliation":[{"name":"Servei d'Hematologia Cl\u00ednica, Grup de Recerca Cl\u00ednica Aplicada en Neoplasies Hematol\u00f2giques, Hospital del Mar Research Institute Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Gomez\u2010Perez","sequence":"additional","affiliation":[{"name":"Servei d'Hematologia Cl\u00ednica, Grup de Recerca Cl\u00ednica Aplicada en Neoplasies Hematol\u00f2giques, Hospital del Mar Research Institute Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Salido","sequence":"additional","affiliation":[{"name":"Laboratori de Citogen\u00e8tica Molecular Servei de Patologia, GRETNHE, Hospital del Mar Research Institute Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Puiggros","sequence":"additional","affiliation":[{"name":"Laboratori de Citogen\u00e8tica Molecular Servei de Patologia, GRETNHE, Hospital del Mar Research Institute Barcelona 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