The clinical implications of these findings may include 1) advanced age at onset for familial CMML (75 and 77 years old); 2) the absence of ASXL1 mutation, suggesting a relatively favorable prognosis; and 3) multi-hit TET2 mutations combined with relatively low VAF values, potentially correlating with good sensitivity to HMA or hydroxyurea therapy observed in both patients. This evidence concerns the gene TET2 and chronic myelomonocytic leukemia.