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. Advances in SCT processes mean this treatment could also be an option for some older patients.

If SCT is not an option, CMML is not curable. In this case, the goal is to relieve symptoms while limiting complications and reducing side effects. Supportive care, such as transfusions, blood cell growth factors, and antibiotics to treat infections, is used to treat all patients with CMML so they can live as long as possible.

Many times no treatment is needed for CMML but if it is, either the drug azacytidine (Vidaza) or decitabine (Dacogen) is often the first choice. These drugs may make blood counts drop for a time after treatment is started. Then, if the drug is working, blood counts rise to levels above those seen before treatment was started.

A major benefit for patients receiving azacytidine or decitabine is less need for transfusions and an improved quality of life. If their disease responds, the patients often are less fatigued and are able to function more normally.

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's rarely used.