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Chronic Myelomonocytic Leukemia (CMML): a Case Report

Desislava Ivanova, Paolina Kamenova, Merlin Mehmed

Abstract

Introduction: Chronic myelomonocytic leukemia (CMML) is a type of cancer that starts in blood-forming cells of the bone marrow and invades the blood. This disease is rare in young people. Almost 9 of 10 of cases are diagnosed in people 60 and older. CMML occurs more often in men than in women. CMML patients have a high number of monocytes in their blood. These monocytes can settle in the spleen or liver and cause hepatosplenomegaly. Low numbers of other types of blood cells cause many of the signs and symptoms of CMML like anemia, leukopenia, thrombocytopenia. CMML has features of both myelodysplastic syndrome and myeloproliferative disorder. CMML is split into 2 groups based on cell counts in the blood and bone marrow. Patients with CMML-1 tend to live longer than those with CMML-2.

Materials and methods: This case report describes a 62-year-old male patient who was admitted to the Haematology Department complaining about episodes of weakness, dizziness, ecchymosis, bone pain and icteric sclera. Two years prior he was diagnosed with ischemic stroke, thrombocytopeniа and myeloma data. Echography, haematological analysis and computer tomographic scan revealed: paraprotein IgM kappa- 4,8%=3,9 g/l; hyperdense areas in the iliac bones (7mm); enlarged lymph nodes in the mediastinum, and hepatosplenomegaly.

Results: A trepanobiopsy showed a hypercellular bone marrow with erythroid hyperplasia and interstitial fibrosis grade 2.  After the cytogenetic and the myelogram the patient was diagnosed with CMML-2.

Conclusion: After treatment, the disease proceeds chronically and it is necessary to do control checkups. About 15% to 30% of CMML patients go on to develop acute myeloid leukemia.


Keywords

chronic myelomonocytic leukemia, CMML


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