Ann Lab Med 2018; 38(5): 481-483  
The 2016 WHO versus 2008 WHO Criteria for the Diagnosis of Chronic Myelomonocytic Leukemia
Yeonsook Moon, M.D.1, Mi Hyang Kim, M.D.2, Hye Ryoun Kim, M.D.3, Jeong-Yeal Ahn, M.D.4, Jungwon Huh, M.D.5, Ji Young Huh, M.D.6, Jae Ho Han, M.D.7, Joon Seong Park, M.D.8, and Sung Ran Cho, M.D.9
Department of Laboratory Medicine1, Inha University School of Medicine, Incheon; Department of Laboratory Medicine2, Kosin University College of Medicine, Busan; Department of Laboratory Medicine3, Chung-Ang University College of Medicine, Seoul; Department of Laboratory Medicine4, Gachon University Gil Hospital, Incheon; Department of Laboratory Medicine5, College of Medicine, Ewha Womans University, Seoul; Department of Laboratory Medicine6, CHA Bundang Medical Center, CHA University, Seongnam; Departments of Pathology7, Hematology-Oncology8, and Laboratory Medicine9, Ajou University School of Medicine, Suwon, Korea
Corresponding author: Sung Ran Cho
Department of Laboratory Medicine, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea
Tel: +82-31-219-5780
Fax: +82-31-219-5778
Received: October 29, 2017; Revised: December 12, 2017; Accepted: April 27, 2018; Published online: September 1, 2018.
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The 2016 WHO diagnostic criteria for chronic myelomonocytic leukemia (CMML) require both absolute and relative monocytosis (≥1×109/L and ≥10% of white blood cell counts) in peripheral blood. Moreover, myeloproliferative neoplasm (MPN) features in bone marrow and/or MPN-associated mutations tend to support MPN with monocytosis rather than CMML. We assessed the impact of the 2016 WHO criteria on CMML diagnosis, compared with the 2008 WHO criteria, through a retrospective review of the medical records of 38 CMML patients diagnosed according to the 2008 WHO classification. Application of the 2016 WHO criteria resulted in the exclusion of three (8%) patients who did not fulfill the relative monocytosis criterion and eight (21%) patients with an MPN-associated mutation. These 11 patients formed the 2016 WHO others group; the remaining 27 formed the 2016 WHO CMML group. The significant difference in the platelet count and monocyte percentage between the two groups indicated that the 2016 WHO criteria lead to a more homogenous and improved definition of CMML compared with the 2008 WHO criteria, which may have led to over-diagnosis of CMML. More widespread use of molecular tests and more sophisticated clinical and morphological evaluations are necessary to diagnose CMML accurately.
Keywords: Chronic myelomonocytic leukemia, WHO classification, Monocytosis

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