Leukemia: Chronic Myelomonocytic

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Treating Leukemia - Chronic Myelomonocytic (CMML) TOPICS

General approach to treatment of chronic myelomonocytic leukemia

Stem cell transplant (SCT) is the only way to cure patients with chronic myelomonocytic (MY-eh-loh-MAH-noh-SIH-tik) leukemia (CMML). It may be the treatment of choice for younger patients when a matched donor is available. This may also be an option for some older patients.

If SCT is not an option, CMML is not curable. In that case, the goal is to relieve symptoms while avoiding the complications and reducing side effects of treatment. Supportive care, such as transfusions, blood cell growth factors, and antibiotics to treat infections, is given to all patients.

If treatment is needed, either of the drugs azacytidine (Vidaza) or decitabine (Dacogen) is often the first choice for CMML. Azacytidine is injected under the skin for 7 days in a row every month. Decitabine is also injected, either once every 8 hours for 3 days, or once a day for 5 days. These drugs may make blood counts drop for a time after treatment is started. Then, if the drug is successful, blood counts rise to levels above those seen before treatment was started.

A major benefit for patients receiving azacytidine or decitabine is a lessened need for transfusions and an improved quality of life. In particular, if their disease responds, the patients have less fatigue and are able to function more normally. Finally, the drugs may increase life span, although this isn't certain.

Treatment with hydroxyurea can help some patients who have high white blood cell counts. This drug can help lower monocyte counts and decrease the need for transfusions. It can also shrink the spleen to help the patient feel more comfortable.

Conventional chemotherapy using drug combinations used to treat acute myeloid leukemia can be an option for patients who are younger and otherwise healthy, but it is rarely used.

Last Medical Review: 01/19/2014
Last Revised: 02/17/2016