Signal pathway mutations are common in CMML and include: JAK2V617F (~10–15%), RAS (KRAS and NRAS ~20–30%), and CBL (~10–20%) mutations.7, 75RAS (KRAS—-Kirsten Rat Sarcoma viral oncogene homolog—chromosome 12p12.1 and NRAS—Neuroblastoma RAS viral oncogene homolog—chromosome 1p13.2) mutations are often associated with a MPN-like CMML phenotype.76 Although univariate analysis studies with RAS mutations have demonstrated inferior outcomes, these findings have not been substantiated in multivariable models.7, 8. This evidence concerns the gene NRAS and chronic myelomonocytic leukemia.