Skip to main content
SpringerLink
Log in

Treatment of chronic myelomonocytic leukemia

  • short review
  • Published:
memo - Magazine of European Medical Oncology Aims and scope Submit manuscript

Summary

Since chronic myelomonocytic leukemia (CMML) has been classified within myelodysplastic syndromes (MDS) for a long time, most treatment data are derived from MDS trials. Owing to the limited number of CMML patients included in these trials, results are analyzed for the whole study population rather than for CMML patients as a distinct group. CMML patients with a myeloproliferative type of disease were often excluded. Therefore, generalization of data gained from MDS trials is very problematic. This review provides a brief overview of the treatment possibilities for patients with CMML. The paucity of existing clinical trials underlines the importance of including CMML patients into clinical studies whenever possible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Vardiman JW, Pierre R, Bain B, Bennett JM, Imbert M, Brunning RD. et al. WHO histological classification of myelodysplastic/myeloproliferative diseases. In: Jaffe ES, Harris NL, Stein H, Vardiman JW, editors. World Health Organization Classification of Tumours: Tomours of the Haematopoietic and Lympoid Tissues. Lyon: International Agency for Research on Cancer (IARC) Press; 2001. pp. 47–59.

    Google Scholar 

  2. Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, et al. The 2016 revision to the World Health Organization classfication fo myeloid neoplasms an acute leukemia. Blood. 2016;127:2391–405.

    Article  CAS  Google Scholar 

  3. Orazi A, Chiu R, O’Malley DP, Czader M, Allen SL, An C, et al. Chronic myelomonocytic leukemia: the role of bone marrow biopsy immunohistolog. Mod Pathol. 2006;19:1536–45.

    Article  CAS  Google Scholar 

  4. Germing U, Gattermann N, Minning H, Heyll A, Aul C. Problems in the classification of CMML-dysplastic versus proliferative type. Leuk Res. 1998;22:871–8.

    Article  CAS  Google Scholar 

  5. Fenaux P, Beuscart R, Lai JL, Jouet JP, Bauters F. Prognostic factors in adult chronic myelomonocytic leukemia: an analysis of 107 cases. J Clin Oncol. 1988;6:1417–24.

    Article  CAS  Google Scholar 

  6. Storniolo AM, Moloney WC, Rosenthal DS, Cox C, Bennett JM. Chronic myelomonocytic leukemia. Leukemia. 1990;4:766–70.

    CAS  PubMed  Google Scholar 

  7. Schuler E, Schroeder M, Neukirchen J, Strupp C, Xicoy A, Kündgen A, Hildebrandt B, Haas R, Gattermann N, Germing U. Refined medullary blast and white blood cell count based classification of chronic myelomonocytic leukemias. Leuk Res. 2014;38:1413–9.

    Article  CAS  Google Scholar 

  8. Bennett JM, Catovsky D, Daniel MT, Flanskin G, Galton DA, Gralnick H, et al. The chronic myeloid leukaemias: guidelines for distinguishing chronic granulocytic, atypical chronic myeloid, and chronic myelomonocytic leukaemia. Proposal by the French-American-British Cooperative Leukaemia Group. Br J Haematol. 1994;87:746–54.

    Article  CAS  Google Scholar 

  9. Itzykson R, Kosmider O, Renneville A, Gelsi-Boyer V, Meggendorfer M, Morabito M, et al. Prognostic score including gene mutations in chronic myelomonocytic leukemia. J Clin Oncol. 2013;31:2428–36.

    Article  CAS  Google Scholar 

  10. Padron E, Garcia-Manero G, Patnaik MM, Itzykson R, Lasho T, Nazha A, et al. An international data set for CMML validates prognostic scoring systems and demonstrates a need for novel prognostication strategies. Blood Cancer J. 2015;5:e333, www.nature.com/bcj doi:10.1038/bcj.2015.53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Papemmanuil E, Gerstung M, Malcovati L, Tauro S, GunemG, Van Loo P, et al. Clinical and biological implications of driver mutations in myelodysplastic syndromes. Blood. 2013;122:3616–27.

    Article  Google Scholar 

  12. Itzykson R, Kosmider O, Renneville A, Morabito M, Preudhomme C, Berthon C, et al. Clonal architecture of chronic myelomonocytic leukemia. Blood. 2013;121:2186–98.

    Article  CAS  Google Scholar 

  13. Wattel E, Guerci A, Hecquet B, Economopoulos T, Copplestone A, Mahe B, Couteaux ME, Resegotti L, Voglova V, Foussard C, Pegourie B, Michaux JL, Doconinck E, Stoppa AM, Mufti G, Oscier D, Fenaux P. A Randomized Trial of Hydroxyurea Versus VP16 in Adult Chronic Myelomonocytic Leukemia. Blood. 1996;88:2480–7.

    CAS  PubMed  Google Scholar 

  14. Beran M, Estey E, O’Brien S, et al. Results of topotecan single-agent theray in patients with myelodysplastic syndromes and chronic myelomonocytic leukemia. Leuk Lymphoma. 1998;31:521–31.

    Article  CAS  Google Scholar 

  15. Fenaux P, Mufti GJ, Hellstrom-Lindberg E, Santini V, Finelli C, Giagounidis A, et al. Efficacy of azacitidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: a randomised, open-label, phase III study. Lancet Oncol. 2009;10:223–32.

    Article  CAS  Google Scholar 

  16. Costa R, Abdulhaq H, Haq B, Shadduck RK, Latsko J, Zenati M, et al. Activity of Azacitidine in Chronic Myelomonocytic Leukemia. Cancer. 2011;117:2690–6.

    Article  CAS  Google Scholar 

  17. Fianchi L, Criscuolo M, Breccia M, Maurillo L, Salvi F, Mansueto G, et al. High rate of remissions in chronic myelomonoctic leukemia treated with 5‑azacytidine: results of an Italian retrospective study. Leuk Lymphoma. 2013;54:658–61.

    Article  CAS  Google Scholar 

  18. Thorpe M, Montalvao A, Pierdomenico F, Moita F, Almeida A. Treatment of chronic myelomonocytic leukemia with 5‑Azacytidine; a case series and literature review. Leuk Res. 2012;36:1071–3.

    Article  CAS  Google Scholar 

  19. Wong E, Seymour JF, Kenealy M, Westerman D, Herbert K, Dickinson M. Treatment of chronic myelomonocytic leukemia with azacitidine. Leuk Lymphoma. 2013;54:878–80.

    Article  CAS  Google Scholar 

  20. Adès L, Sekeres MA, Wolfromm A, Teichman ML, Tiu RV, Itzykson R, et al. Predictive factors of response and survival among chronic myelomonocytic leukemia patients treated with azacitidine. Leuk Res. 2013;37:609–13.

    Article  Google Scholar 

  21. Pleyer L, Germing U, Sperr WR, Linkesch W, Burgstaller S, Stauder R, et al. Azacitidine in CMML: matched-pair analysis of daily-life patients reveal modest effects on clinical course and survival. Leuk Res. 2014;38:475–83.

    Article  CAS  Google Scholar 

  22. Feldman E, Cortes J, DeAngelo DJ, et al. On the use of lonafarnib in myelodysplastic syndrome and chronic myelomonocytic leukemia. Leukemia. 2008;22:1707–11.

    Article  CAS  Google Scholar 

  23. Sliitonen T, Timonen T, Juvonen E, et al. Valproic acid combined with 13-cis retinoic acid and 1,25-dihydroxyvitamin D3 in the treatment of patients with myelodysplastic syndromes. Haematologica. 2007;92:1119–22.

    Article  Google Scholar 

  24. Padron E, Dezern A, Andrade-Campos M, Vaddi K, Scherle P, Zhang Q, et al. Multi-Institutional Phase 1 Trial of Ruxolitinib in Patients with Chronic Myelomonocytic Leukemia (CMML). Clin Cancer Res. 2016;22(15):3746–54.

    Article  CAS  Google Scholar 

  25. Kröger N, Zabelina T, Guardiola P, Runde V, Sierra J, van Biezen A, Niederwieser D, Zander AR, de Witte T. Allogeneic stem cell transplantation of adult chronic myelomonocytic leukaemia. A report on behalf of the Chronic Leukaemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT). Br J Haematol. 2002;118:67–73.

    Article  Google Scholar 

  26. Mittal P, Saliba RM, Giralt SA, Shahjahan M, Cohen AI, Karandish S, Onida F, Beran M, Champlin RE, de Lima M. Allogeneic transplantation: a therapeutic option for myelofibrosis, chronic myelomonocytic leukemia and Philadelphia-negative/BCR-ABL-negative chronic myelogenous leukemia. Bone Marrow Transplant. 2004;33:1005–9.

    Article  CAS  Google Scholar 

  27. Krishnamurthy P, Lim ZY, Nagi W, Kenyon M, Mijovic A, Ireland R, Marsh J, Ho AYL, Mufti GJ, Pagliuca A. Allogeneic haematopoietic SCT for chronic myelomonocytic leukaemia: a single-centre experience. Bone Marrow Transplant. 2010;45:1502–7.

    Article  CAS  Google Scholar 

  28. Eissa H, Gooley TA, Sorror ML, Nguyen F, Scott BL, Doney K, Loeb KR, Martin PJ, Pagel JM, Radich JP, Sandmaier VM, Warren EH, Storb R, Appelbaum FR, Deeg J. Allogeneic Hematopoietic Cell Transplantation for Chronic Myelomonocytic Leukemia: Relapse-Free Survival is Determined by Karyotype and Comorbidities. Biol Blood Marrow Transplant. 2010;17(6):908–15.

    Article  Google Scholar 

  29. Kongtim P, Popat U, Jimenez A, et al. Treatment with hypomethylating agents before allogeneic stem cell transplant improves progression-free survival for patietns with chronic myelomonocytic leukemia. Biol Blood Marrow Transplant. 2016;22:47–53.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Abteilung für Innere Medizin IV, Klinikum Wels-Grieskirchen, Grieskirchnerstr. 42, 4600, Wels, Austria

    Sonja Burgstaller MD

Authors
  1. Sonja Burgstaller MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sonja Burgstaller MD.

Ethics declarations

Conflict of interest

S. Burgstaller received research support from Celgene.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Burgstaller, S. Treatment of chronic myelomonocytic leukemia. memo 9, 168–171 (2016). https://doi.org/10.1007/s12254-016-0291-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12254-016-0291-3

Keywords

Search

Navigation