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. The gene discussed is ASXL1; the disease is chronic myelomonocytic leukemia.