General Approach to Treating Chronic Myelomonocytic Leukemia (CMML)

Treatment for people with chronic myelomonocytic leukemia (CMML) depends on a number of factors, such as:

• A person's age and overall health (including if they are eligible for a stem cell transplant)
• Whether the CMML is causing symptoms and how fast it seems to be progressing
• Whether the CMML is in a higher or lower risk group
• A person's preferences and goals for treatment

Treating CMML if a stem cell transplant can be done

In general, a stem cell transplant (SCT) is the only realistic way to try to cure CMML. Other treatments aim to treat symptoms caused by the CMML and possibly slow its progression.

Stem cell transplant is often the treatment of choice for younger people with higher-risk CMML, if a matched stem cell donor is available. Because of advances in SCT, this treatment might also be an option for some older people.

In general, SCT hasn't shown to be better than other treatments for people with lower-risk CMML.

Treating CMML if stem cell transplant is not an option

If SCT isn’t an option, the main goal of treatment is to relieve symptoms from the CMML while also limiting complications and reducing side effects.

Supportive care is used to treat all people with CMML, so they can live as well as possible. This type of care can include transfusions, blood cell growth factors, and antibiotics to treat infections.

For people who aren't having symptoms from CMML, treatment might not be needed right away. Instead, doctors may just watch the CMML closely.

If treatment is needed, chemotherapy is typically the first choice. This is done with either hydroxyurea or one of the hypomethylating agents (azacitidine or decitabine). The choice often depends on the types of symptoms a person is having and whether those symptoms need to be controlled.

For example:

• A major benefit of azacitidine or decitabine is a reduced need for blood transfusions and an improved quality of life. If the CMML responds, people are often less fatigued and can function more normally.
• Treatment with hydroxyurea can help some people with 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 a person feel more comfortable.

If one type of drug doesn't work, another can often be tried.

Because CMML can often be hard to treat, taking part in a clinical trial testing a newer treatment might be a good option for some people.