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Growth Factors and Similar Medicines for Chronic Myelomonocytic Leukemia

Shortages of blood cells cause many of the symptoms in people with chronic myelomonocytic leukemia (CMML). Hematopoietic growth factors are hormone-like substances that stimulate bone marrow to make more blood cells. These substances occur naturally in the body, but they can also be made in the lab in large amounts. This lets patients get larger doses of these growth factors than their body would normally make.


Giving a person growth factor drugs is one way to raise low blood cell counts. But transfusions of blood components (red blood cells or platelets) are typically used more often. Growth factor drugs are usually given by subcutaneous (under the skin) injections.

Growth factors to raise red blood cell levels

Epoetin alfa (Epogen or Retacrit) is a manmade version of the growth factor erythropoietin, which tells the body to make more red blood cells. It can often help lower the number of red blood cell transfusions a person needs. Giving both epoetin and G-CSF (see "Growth factors to raise white blood cells") can sometimes improve the person's response to epoetin.

Darbepoetin alfa (Aranesp) is a long-acting form of epoetin. It works in the same way can be given less often.

Luspatercept (Reblozyl) isn’t a growth factor, but it is another medicine that can help the body make more healthy red blood cells. Known as a red blood cell maturation agent, this drug affects TGF-β proteins in the bone marrow. TGF-β proteins normally help control how quickly new cells in the bone marrow mature into functioning red blood cells, so that there aren’t too many or too few of them in the body. By acting on specific TGF-β proteins, luspatercept helps the bone marrow make more healthy, fullgrown red blood cells.

Growth factors to raise white blood cell levels

Granulocyte colony stimulating factor (G-CSF, filgrastim, Neupogen or other brand names) can improve white blood cell production. This is not used routinely to prevent infections, but it can help some patients whose main problem is a shortage of white blood cells and who have frequent infections.

Pegfilgrastim (Neulasta, other brand names) is a long-acting form of G-CSF. It works in the same way but can be given less often.

Medicines to raise blood platelet levels

Drugs called thrombopoietin-receptor agonists, such as romiplostim (Nplate) and eltrombopag (Promacta) might help some people with CMML who have very low platelet levels.

A drug called oprelvekin (interleukin-11, IL-11, or Neumega) can be used to raise platelet counts after chemotherapy and in some other diseases. But for most people with CMML, this drug has not been found to be very helpful.


The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as editors and translators with extensive experience in medical writing.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Myelodysplastic Syndromes. Version 1.2024. Accessed at on May 18, 2024. 

Padron E. Chronic myelomonocytic leukemia: Management and prognosis. UpToDate. 2024. Accessed at on May 18, 2024.

Sekeres MA, Platzbecker U. Myelodysplastic syndromes/neoplasms (MDS): Management of hematologic complications in lower-risk MDS. UpToDate. 2024. Accessed at on May 18, 2024.

Last Revised: May 21, 2024

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