In a patient with persistent, otherwise unexplained mild anemia (eg Hb 12 g/dL) and a pathogenic somatic mutation identified on peripheral blood myeloid NGS, when do you pursue bone marrow biopsy to evaluate for CCUS/MDS rather than monitoring expectantly?

How do you approach evaluation of mild anemia with a pathogenic somatic mutation on peripheral myeloid NGS?

• Perform bone marrow biopsy in all patients with unexplained anemia and a pathogenic myeloid mutation.
• Pursue biopsy based on molecular risk factors (e.g., mutation type, VAF, or number of mutations).
• Reserve biopsy for worsening anemia, additional cytopenias, or other concerning clinical findings.
• Other