{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T08:28:54Z","timestamp":1771921734615,"version":"3.50.1"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:00:00Z","timestamp":1768435200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background and objective<\/jats:title>\n                    <jats:p>Chronic myelomonocytic leukemia (CMML) is a malignant clonal disorder characterized by both myelodysplastic syndrome (MDS) and myeloproliferative neoplasm (MPN) features. Due to its relatively low incidence, there remains a lack of consensus regarding diagnostic criteria and therapeutic strategies within the academic community, which poses significant challenges in clinical management. This study aims to investigate the clinical manifestations, diagnostic approaches, therapeutic interventions, and prognostic factors associated with CMML, with the goal of providing evidence-based insights for future basic research and clinical practice in the field of hematology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Clinical data from 271 CMML patients treated at five tertiary hospitals between January 2015 and May 2025 were collected and analyzed. The clinical characteristics, treatment modalities, and outcomes were systematically reviewed. Comprehensive prognostic evaluation was conducted using the Kaplan\u2013Meier method, Log-rank test, and Cox proportional hazards regression model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 271 CMML patients were enrolled, including 178 males (65.68%) and 93 females (34.32%), with a median age at diagnosis of 66\u202fyears (range: 26\u201389). According to the FAB classification, 109 cases (40.22%) were classified as myelodysplastic-type CMML (MD-CMML), and 162 cases (59.78%) as myeloproliferative-type CMML (MP-CMML). Based on the WHO classification, the distribution was as follows: 59 cases (21.77%) of CMML-0, 66 cases (24.35%) of CMML-1, and 146 cases (53.87%) of CMML-2. First-line treatment primarily involved chemotherapy, while 107 patients received only supportive care. Treatment response was evaluable in 199 patients: 97 cases achieved complete remission (CR), 63 cases achieved partial remission (PR), 32 cases had stable disease (SD), and 7 cases experienced disease progression (PD). Follow-up was completed by June 30, 2025. Among the 271 patients, 159 cases (58.67%) were alive, 97 cases (35.79%) had died, and 15 cases (5.54%) were lost to follow-up. The median overall survival (OS) was 23.5\u202fmonths (range: 0.5\u2013109). Multivariate analysis identified that factors associated with poor OS included elevated neutrophil count, increased monocyte count, decreased hemoglobin (HB) levels, elevated lactate dehydrogenase (LDH), increased \u03b22-microglobulin (\u03b22-MG), and peripheral blood blast count \u22655% (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), while the decreased HB and peripheral blood blast count \u22655% was independent adverse prognostic factors for OS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CMML is a highly heterogeneous disease with generally unfavorable clinical outcomes. Although chemotherapy can induce remission in some cases, long-term survival remains limited. The enrollment in clinical trials should be encouraged to improve patient prognosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1711684","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T05:14:18Z","timestamp":1768454058000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical perception and novel insights of chronic myelomonocytic leukemia: a 10-year multi-center retrospective study"],"prefix":"10.3389","volume":"12","author":[{"given":"Yanquan","family":"Liu","sequence":"first","affiliation":[{"name":"Jiangxi Health Commission Key Laboratory of Leukemia, Department of Hematology, The Affiliated Ganzhou Hospital (Ganzhou People\u2019s Hospital), Jiangxi Medical College, Nanchang University","place":["Ganzhou, Jiangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhimin","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Gannan Medical University","place":["Ganzhou, Jiangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingdong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Jiangxi Health Commission Key Laboratory of Leukemia, Department of Hematology, The Affiliated Ganzhou Hospital (Ganzhou People\u2019s Hospital), Jiangxi Medical College, Nanchang University","place":["Ganzhou, Jiangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaojun","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Hematology, The Affiliated Hospital of Putian University","place":["Putian, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianzhen","family":"Shen","sequence":"additional","affiliation":[{"name":"Fujian Institute of Hematology, National Key Laboratory of Hematology, Fujian Medical University Union Hospital","place":["Fuzhou, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Honghua","family":"He","sequence":"additional","affiliation":[{"name":"Department of Hematology, The Affiliated Hospital (First School of Clinical Medicine) of Guangdong Medical University","place":["Zhanjiang, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Yin","sequence":"additional","affiliation":[{"name":"Fujian Institute of Hematology, National Key Laboratory of Hematology, Fujian Medical University Union Hospital","place":["Fuzhou, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huidong","family":"Guo","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital (First Clinical Medical College) of Gannan Medical University","place":["Ganzhou, Jiangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fanlin","family":"Zeng","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital (First Clinical Medical College) of Gannan Medical University","place":["Ganzhou, Jiangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1097\/MOH.0000000000000689","article-title":"Abnormal monocyte differentiation and function in chronic myelomonocytic leukemia","volume":"29","author":"Dhawan","year":"2022","journal-title":"Curr Opin Hematol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1002\/hon.745","article-title":"Chronic myelomonocytic leukemia: lost in classification?","volume":"23","author":"Bowen","year":"2005","journal-title":"Hematol Oncol"},{"key":"ref3","first-page":"83","article-title":"WHO classification of tumours of haematopoietic and lymphoid tissues in 2008: an overview","volume":"102","author":"Sabattini","year":"2010","journal-title":"Pathologica"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1182\/blood-2009-03-209262","article-title":"The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes","volume":"114","author":"Vardiman","year":"2009","journal-title":"Blood"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1111\/bjh.20213","article-title":"Clinical management of CMML-state of the art","volume":"207","author":"Nachtkamp","year":"2025","journal-title":"Br J Haematol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2391","DOI":"10.1182\/blood-2016-03-643544","article-title":"The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia","volume":"127","author":"Arber","year":"2016","journal-title":"Blood"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1016\/s0145-2126(97)00192-6","article-title":"Problems in the classification of CMML--dysplastic versus proliferative type","volume":"22","author":"Germing","year":"1998","journal-title":"Leuk Res"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1053\/j.seminoncol.2011.11.004","article-title":"Chronic myelomonocytic leukemia and atypical chronic myeloid leukemia: novel pathogenetic lesions","volume":"39","author":"Muramatsu","year":"2012","journal-title":"Semin Oncol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1007\/s11899-025-00753-2","article-title":"Contemporary CMML risk stratification and management","volume":"20","author":"Sastow","year":"2025","journal-title":"Curr Hematol Malig Rep"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1111\/j.1537-2995.2012.03819.x","article-title":"Red blood cell alloimmunization in transfused patients with myelodysplastic syndrome or chronic myelomonocytic leukemia","volume":"53","author":"Sanz","year":"2013","journal-title":"Transfusion"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1002\/ajh.25486","article-title":"DDX41 mutations in myeloid neoplasms are associated with male gender, TP53 mutations and high-risk disease","volume":"94","author":"Quesada","year":"2019","journal-title":"Am J Hematol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1408","DOI":"10.1182\/blood-2016-05-714030","article-title":"Integrating clinical features and genetic lesions in the risk assessment of patients with chronic myelomonocytic leukemia","volume":"128","author":"Elena","year":"2016","journal-title":"Blood"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1111\/bjh.19060","article-title":"Phenotypic subtypes of leukaemic transformation in chronic myelomonocytic leukaemia","volume":"203","author":"Montalban-Bravo","year":"2023","journal-title":"Br J Haematol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1182\/blood-2017-04-736421","article-title":"How I treat chronic myelomonocytic leukemia","volume":"130","author":"Solary","year":"2017","journal-title":"Blood"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e393","DOI":"10.1038\/bcj.2016.5","article-title":"Cytogenetic and molecular abnormalities in chronic myelomonocytic leukemia","volume":"6","author":"Patnaik","year":"2016","journal-title":"Blood Cancer J"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1002\/ajh.24108","article-title":"Prognostic impact of acquisition of cytogenetic abnormalities during the course of chronic myelomonocytic leukemia","volume":"90","author":"Tang","year":"2015","journal-title":"Am J Hematol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"375","DOI":"10.3324\/haematol.2010.030957","article-title":"Cytogenetic risk stratification in chronic myelomonocytic leukemia","volume":"96","author":"Such","year":"2011","journal-title":"Haematologica"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1002\/ajh.23751","article-title":"Cytogenetic risk stratification of 417 patients with chronic myelomonocytic leukemia from a single institution","volume":"89","author":"Tang","year":"2014","journal-title":"Am J Hematol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1007\/s10354-025-01080-0","article-title":"Characteristics of NRAS-mutated patients with chronic myelomonocytic leukemia in a national (ABCMML) and an international cohort (cBioPortal)","volume":"175","author":"Qian","year":"2025","journal-title":"Wien Med Wochenschr"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"blood.2024027170","DOI":"10.1182\/blood.2024027170","article-title":"BLAST: a globally applicable and molecularly versatile survival model for chronic myelomonocytic leukemia","volume":"146","author":"Tefferi","year":"2025","journal-title":"Blood"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"S2152-2650(25)00109-0","DOI":"10.1016\/j.clml.2025.03.016","article-title":"Characterization of indolent chronic myelomonocytic leukemia phenotypes and dynamic features of disease progression","volume":"25","author":"Aguirre","year":"2025","journal-title":"Clin Lymphoma Myeloma Leuk"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1038\/s41408-025-01245-5","article-title":"Oral decitabine cedazuridine with and without venetoclax in higher-risk myelodysplastic syndromes or chronic myelomonocytic leukemia: a propensity score-matched study","volume":"15","author":"Bataller","year":"2025","journal-title":"Blood Cancer J"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"005007","DOI":"10.12890\/2025_005007","article-title":"Caught in the crossfire: a case of splenic infarction amid G-CSF therapy in chronic myelomonocytic leukaemia","volume":"12","author":"Peshin","year":"2025","journal-title":"Eur J Case Rep Intern Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"3746","DOI":"10.1158\/1078-0432.CCR-15-2781","article-title":"A multi-institution phase I trial of Ruxolitinib in patients with chronic myelomonocytic leukemia (CMML)","volume":"22","author":"Padron","year":"2016","journal-title":"Clin Cancer Res"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"6095","DOI":"10.1158\/1078-0432.CCR-21-0935","article-title":"Integrated human and murine clinical study establishes clinical efficacy of ruxolitinib in chronic myelomonocytic leukemia","volume":"27","author":"Hunter","year":"2021","journal-title":"Clin Cancer Res"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1182\/blood.2019004352","article-title":"Phase 1 study of lenzilumab, a recombinant anti-human GM-CSF antibody, for chronic myelomonocytic leukemia","volume":"136","author":"Patnaik","year":"2020","journal-title":"Blood"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2901","DOI":"10.1038\/s41467-021-23186-w","article-title":"RAS mutations drive proliferative chronic myelomonocytic leukemia via a KMT2A-PLK1 axis","volume":"12","author":"Carr","year":"2021","journal-title":"Nat Commun"},{"key":"ref28","year":""}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1711684\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T06:54:40Z","timestamp":1771916080000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1711684\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,15]]},"references-count":28,"alternative-id":["10.3389\/fmed.2025.1711684"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1711684","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,15]]},"article-number":"1711684"}}