Supportive Therapy for People with Chronic Myelomonocytic Leukemia (CMML)

Supportive therapy is treatment aimed at preventing or relieving symptoms. The main purpose of this type of treatment is to improve comfort and quality of life, no matter the type of cancer or the goal of treatment.

You might also hear supportive care referred to as palliative care, symptom management, or comfort care.

Treating chronic myelomonocytic leukemia (CMML) can often help with the symptoms it causes, but some treatments are aimed more at the symptoms themselves. For many people with CMML, one of the main goals of treatment is to prevent the problems caused by low blood cell counts. These treatments are discussed below.

Treating low red blood cell counts (anemia) as palliative care for CMML

Having low red blood cell counts (anemia) can cause severe fatigue (feeling very tired), shortness of breath, and other symptoms. Treating the anemia can often help you feel better and allow you to be more active.

Red blood cell transfusions

People with CMML and anemia that’s causing symptoms might be helped by red blood cell transfusions.

Some people might be concerned about getting an infection (such as hepatitis or HIV) from a blood transfusion. But this risk is extremely low, and the benefits of getting the transfused cells greatly outweigh this risk.

Treating iron build-up from blood transfusions

People with CMML often need a lot of blood transfusions. This can cause excess iron to build up in the body. This extra iron can deposit in the liver and heart, affecting how well the organs work. This iron build-up is usually seen only in people who get many transfusions over a period of years.

Drugs called chelating agents bind with the iron so the body can get rid of it. They can be given to people who develop iron overload from red blood cell transfusions (unless they have poor kidney function).

• Deferoxamine (Desferal) is usually given as an infusion under the skin, using a small, portable pump. This must be done slowly (over at least 8 hours) each day or on most days of the week.
• Deferasirox (Exjade, Jadenu) is a newer drug that is taken once a day by mouth (as a tablet, dissolved in juice or water, or sprinkled on food).  

To learn more about red blood cell transfusions, see Blood Product Transfusions.

Treating low platelet counts as palliative care for CMML

People with CMML who have low platelet counts might bleed or bruise easily. There are a few treatments that can help with this.

Platelet transfusions

To raise their platelet levels, people with very low platelet counts might need transfusions of platelets collected from donors. This is especially true for people who have signs of bleeding as a result of a low platelet count.

For more information about platelet transfusions, see Blood Product Transfusions.

Platelet growth factors and other medicines

For people who aren’t helped by platelet transfusions, some types of medicines might be used:

• One option might be treatment with an antifibrinolytic agent, such as aminocaproic acid (Amicar).
• Drugs called thrombopoietin receptor agonists (TPO-RAs), such as romiplostim (Nplate) and eltrombopag (Promacta), might help raise platelet counts in some people with very low platelet levels.

Treating low white blood cell counts as palliative care for CMML

People with CMML tend to get infections very easily, and the infections are more likely to be serious. It's important to avoid cuts and scrapes and take care of them right away if they do happen.

If you have low white blood cell counts, tell your health care team right away if you notice any possible signs of infection, such as:

• Fever
• Signs of pneumonia (cough, shortness of breath) 
• Signs of a urinary tract infection (such as burning when urinating)

White blood cell growth factors

Growth factors are hormone-like substances that can help your bone marrow make more new blood cells. Man-made versions of some growth factors can be given (often as injections under the skin) to help raise white blood cell counts.

• Granulocyte colony-stimulating factor (G-CSF, filgrastim, Neupogen, other brand names) can help the body make more white blood cells. This medicine isn’t used routinely to prevent infections, but it can help some people with CMML who have a shortage of normal white blood cells and 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.

Antibiotics and vaccines

Known or suspected bacterial infections are typically treated with antibiotics. But antibiotics aren’t usually given to help prevent infections in people with low white blood cell counts.

Because people with CMML are often at higher risk of infections, it’s important to stay up to date with vaccines to help prevent them. To learn more, see Vaccinations and Flu Shots for People with Cancer.

Also, see Infections in People with Cancer for more details.