慢性粒单核细胞白血病（CMML）是一种侵袭性克隆干细胞疾病，属于骨髓增生异常/骨髓增殖（MDS/MPN）重叠肿瘤。 CMML 与 MDS 和 MPN 具有相同的特征，但具有独特的分子和临床特征。 CMML 特异性预后模型、反应标准和专门的临床试验的存在强调了其独特而复杂的生物学特性。影响骨髓微环境、免疫反应以及表观遗传失调和促炎症信号传导之间复杂平衡的年龄相关变化是这种疾病的特征，这些变化共同给治疗带来了重大的科学和临床挑战。 CMML 是一种与衰老相关的临床异质性肿瘤，批准的治疗选择有限，是一个医疗需求未得到满足的领域。这篇综述对当前对驱动 CMML 进化的分子机制及其在不断发展的精准医学领域中的临床表现的理解进行了全面分析。根据最新的分子发现，我们强调了现有疗法的缺陷，并强调了有前途的研究药物。所讨论的许多生物学发现在一系列急性和慢性髓系肿瘤以及克隆造血中都是共有的，从而扩大了本综述的范围。

Chronic myelomonocytic leukemia (CMML) is an aggressive clonal stem cell disorder categorized amongst myelodysplastic/myeloproliferative (MDS/MPN) overlap neoplasms. While sharing features with both MDS and MPN, CMML has distinct molecular and clinical profiles. The presence of CMML-specific prognostic models, response criteria, and dedicated clinical trials underscores a unique and complex biology. Agerelated changes affecting the bone marrow microenvironment, immune responses, and the intricate balance between epigenetic deregulation and proinflammatory signaling are characteristic of this disease, collectively posing significant scientific and clinical challenges in management. CMML is an ageing-related, clinically heterogeneous neoplasm with limited approved therapeutic options, representing an area of unmet medical need. This review offers a comprehensive analysis of the current understanding of the molecular mechanisms driving CMML evolution and its clinical manifestations within the ever-evolving landscape of precision medicine. In light of the most recent molecular discoveries, we highlight the pitfalls of existing therapies and underscore promising investigational agents. Many of the biological findings discussed are shared across a spectrum of acute and chronic myeloid neoplasms, as well as clonal hematopoiesis, broadening the scope of this review.