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If suspicion of a CMCD is high (clonality prediction score 2), the criterion standard for diagnosing SM or MMAS is a bone marrow biopsy, which should ideally be performed in a center with expertise in SM since the burden of abnormal mast cells is typically quite low in those patients [49, 55, 65]

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(2018) identified a distinct microbial signature with elevated Lactobacillus and decreased Veillonellaceae , correlating with greater symptom severity and poorer 12-month remission