Table 22.

Diagnostic criteria for juvenile myelomonocytic leukemia

I. Clinical and hematologic features (the first 2 features are present in most cases; the last 2 are required)
• PB monocyte count ≥ 1 × 109/L*
• Splenomegaly
• Blast percentage in PB and BM < 20%
• Absence of BCR::ABL1 
II. Genetic studies (1 finding required)
• Somatic mutation in PTPN11 or KRAS or NRAS or RRAS
• Germline NF1 mutation and loss of heterozygosity of NF1 or clinical diagnosis of neurofibromatosis type 1
• Germline CBL mutation and loss of heterozygosity of CBL§ 
I. Clinical and hematologic features (the first 2 features are present in most cases; the last 2 are required)
• PB monocyte count ≥ 1 × 109/L*
• Splenomegaly
• Blast percentage in PB and BM < 20%
• Absence of BCR::ABL1 
II. Genetic studies (1 finding required)
• Somatic mutation in PTPN11 or KRAS or NRAS or RRAS
• Germline NF1 mutation and loss of heterozygosity of NF1 or clinical diagnosis of neurofibromatosis type 1
• Germline CBL mutation and loss of heterozygosity of CBL§ 
*

This monocyte threshold is not reached in approximately 7% of cases.

Splenomegaly is absent in 3% of cases at presentation.

Germline mutations (indicating Noonan syndrome) need to be excluded.

§

Occasional cases with heterozygous splice site mutations.

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