Case report: CMML initially diagnosed as ITP in one patient, stabilized with decitabine

A case report describes the diagnostic and treatment course of one patient whose condition was initially diagnosed as primary immune thrombocytopenia (ITP). After immunosuppressive treatment, the patient's platelets temporarily rebounded. However, subsequent clinical and laboratory changes—including increased white blood cells and monocyte proportion—prompted further investigation. Bone marrow morphology and next-generation sequencing testing identified typical CMML-related mutations, leading to a final diagnosis of chronic myelomonocytic leukemia (CMML). The patient's condition stabilized after receiving decitabine chemotherapy. Safety and tolerability data for the treatments were not reported. The report notes that immunosuppressive treatment was given initially, but no comparator was described, and follow-up duration was not specified. Key limitations include the nature of a single case report, which lacks statistical analysis, a control group, and generalizability. The authors suggest clinical attention to potential clonal bone marrow diseases in ITP patients who are refractory or have a poor response to treatment. They note that early bone marrow morphological and molecular detection may help clarify diagnosis, guide treatment, and potentially improve prognosis. However, this remains a hypothesis based on one case, and no efficacy or safety conclusions can be drawn.