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The classical nature of distinctive CMML monocytes

Peter L. Greenberg

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  • Monocyte subsets in CMML

    A 2015 article by Selimoglu-Buet et al. 1 reported on the diagnostic value of monocyte subset assessment in chronic myelomonocytic leukemia. An increase of the CD14++ CD16- classical monocytes above a cut-off of 94% of all monocytes was shown to be characteristic for CMML. More recently these findings were confirmed by Talati et al. 2 and it was shown that MDS patients with high and low percentage of classical monocytes have a different survival time indicating that this diagnostic tool may improve classification by identification of a „CMML-like MDS“ entity. The importance of these findings was highlighted by an INSIDE BLOOD COMMENTARY 3. What has not been taken into account in the discussion of these intriguing findings is the original 1999 report by Vuckovic et al 4. Albeit published under a title stressing dendritic cells, the study reports that “The CD14lowCD16+ monocyte subpopulation was not found in CMML patients.” The flow cytometry data in this study clearly show that all CD16+ monocytes are absent in CMML, i.e. the cells, which nowadays are subdivided into non-classical and intermediate monocytes according to the IUIS WHO nomenclature 5. Selimoglu-Buet et al. 1 and Talati et al. 2 have taken the Vuckowic findings further by looking at the complementary increase of classical monocytes to show that this is specific to CMML as compared to other non-CMML entities including myelodysplastic syndromes and myeloproliferative neoplasms.
    Of note, the Vuckovic study...

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    Conflict of Interest:
    None declared.