General approach to treatment of chronic myelomonocytic leukemia

Stem cell transplant (SCT) is the only way to cure patients with chronic myelomonocytic 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, may be 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 given by injection under the skin for 7 days in a row every month. Decitabine is also given as an injection, either once every 8 hours for 3 days, or once a day for 5 days. These drugs may cause a drop in blood counts for a time after treatment is started. Then, if the drug is successful, blood counts rise to levels above those seen before chemotherapy 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 size of the spleen to help the patient feel more comfortable.