title: Management recommendations for chronic myelomonocytic leukemia: consensus statements from the SIE, SIES, GITMO groups.
abstract: With the aim of reviewing critical concepts and producing recommendations for the management of chronic myelomonocytic leukemia, key questions were selected according to the criterion of clinical relevance. Recommendations were produced using a Delphi process and four consensus conferences involving a panel of experts appointed by the Italian Society of Hematology and affiliated societies. This report presents the final statements and recommendations, covering patient evaluation at diagnosis, diagnostic criteria, risk classification, first-line therapy, monitoring, second-line therapy and allogeneic stem cell transplantation. For the first-line therapy, the panel recommended that patients with myelodysplastic-type chronic myelomonocytic leukemia and less than 10% blasts in bone marrow should be managed with supportive therapy aimed at correcting cytopenias. In patients with myelodysplastic-type chronic myelomonocytic leukemia with a high number of blasts in bone marrow (≥ 10%), supportive therapy should be integrated with the use of 5-azacytidine. Patients with myeloproliferative-type chronic myelomonocytic leukemia with a low number of blasts (<10%) should be treated with cytoreductive therapy. Hydroxyurea is the drug of choice to control cell proliferation and to reduce organomegaly. Patients with myeloproliferative-type chronic myelomonocytic leukemia, and a high number of blasts should receive polychemotherapy. Both in myelodysplastic-type and myeloproliferative-type chronic myelomonocytic leukemia, allogeneic stem cell transplantation should be offered within clinical trials in selected patients.
authors.affiliation: Hematology - Bone Marrow Transplantation Center, Fondazione IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Onida
authors.forename: Giovanni
authors.initials: G
authors.lastname: Barosi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Leone
authors.forename: Luca
authors.initials: L
authors.lastname: Malcovati
authors.forename: Enrica
authors.initials: E
authors.lastname: Morra
authors.forename: Valeria
authors.initials: V
authors.lastname: Santini
authors.forename: Giorgina
authors.initials: G
authors.lastname: Specchia
authors.forename: Sante
authors.initials: S
authors.lastname: Tura
mesh_terms: D019468:Disease Management; D006801:Humans; D015477:Leukemia, Myelomonocytic, Chronic / Q000175:diagnosis / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012955:Societies, Medical / Q000592:standards*; D014944:World Health Organization