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 a person is eligible for a stem cell transplant)
• If the CMML is causing symptoms, and how fast it seems to be progressing
• If the CMML is in a higher- or lower-risk group
• A person's preferences and goals for treatment

In general, a stem cell transplant (SCT) is the only realistic way to try to cure CMML, while other treatments are aimed at treating symptoms CMML causes and possibly slowing its progression.

An SCT may be the treatment of choice for younger people with higher-risk CMML, if a matched stem cell donor is available. Advances in SCT means this treatment might also be an option for some older patients as well. In general, SCT hasn't been shown to be better than other treatments in people with lower-risk CMML.

If SCT is not an option, 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 people with CMML so they can live as long as possible.

In people who aren't having symptoms from CMML, treatment might not be needed right away. The doctors may instead just watch the CMML closely. If treatment is needed, chemotherapy is typically the first choice, with either hydroxyurea or one of the hypomethylating agents (azacitidine or decitabine). The choice often depends on what types of symptoms a person is having that need to be controlled. For example:

• A major benefit receiving azacitidine or decitabine is less need for blood transfusions and an improved quality of life. If the CMML responds, people are often less fatigued and are able to 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 the person feel more comfortable.

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