Chronic Myelomonocytic Leukemia (CMML)

Chronic Myelomonocytic Leukemia (CMML)

 

Chronic Myelomonocytic Leukemia (CMML) is a rare type of blood cancer affecting the bone marrow, which produces different types of blood cells. In CMML, there is an overproduction of certain types of white blood cells called monocytes and myelocytes, which can accumulate in the bone marrow and bloodstream.

Types of Chronic Myelomonocytic Leukemia
There are two types of Chronic Myelomonocytic Leukemia (CMML), which are based on the percentage of blasts (immature blood cells) present in the bone marrow and bloodstream –

1. CMML-1 – This type of CMML has less than 10% blasts in the bone marrow and less than 1% blasts in the bloodstream.
2. CMML-2 – This type of CMML has between 10% to 19% blasts in the bone marrow or between 1% to 19% blasts in the bloodstream.

The percentage of blasts is an important factor in determining the severity of the disease and treatment options. CMML-2 is generally considered more aggressive than CMML-1 and may require more intensive treatment.

In addition to these two types, CMML can also be classified based on the genetic mutations present in the cancer cells. Some of the common genetic mutations found in CMML include mutations in genes such as TET2, ASXL1, and SRSF2. The presence of certain genetic mutations may also affect the prognosis and treatment options for CMML.

Chronic Myelomonocytic Leukemia (CMML)

Causes and Risk Factors

The actual cause of chronic myelomonocytic leukemia (CMML) is not yet known. However, research suggests that certain genetic mutations and changes in the DNA of bone marrow cells can contribute to the development of CMML.

Some factors that may increase a person’s risk of developing CMML include –

1. Age – CMML is most commonly diagnosed in older adults, particularly those over the age of 60.
2. Gender – Men are slightly more likely than women to develop CMML.
3. Prior exposure to chemotherapy or radiation therapy – Exposure to certain chemotherapy drugs or radiation therapy for other types of cancer may increase the risk of developing CMML.
4. Certain genetic disorders – Some genetic disorders, such as neurofibromatosis type 1, Noonan syndrome, and Shwachman-Diamond syndrome, may increase the risk of developing CMML.
5. Family history – While most cases of CMML are not inherited, having a first-degree relative (such as a parent or sibling) with the disease may increase the risk slightly.
6. Exposure to chemicals – Exposure to certain chemicals, such as benzene or pesticides, may increase the risk of developing CMML.

Having one or more of these risk factors does not necessarily mean that a person will develop CMML. However, if you have any concerns about your risk for CMML or are experiencing symptoms, talk to your doctor about getting tested. Early diagnosis and treatment can help improve your outlook and quality of life.

Symptoms

The symptoms of Chronic Myelomonocytic Leukemia are not common. Some people may or may not experience leukemia symptoms. However, certain symptoms one may notice are –

• Enlarged spleen
• Fatigue and weakness
• Fever
• Unexplained weight loss
• Frequent infections
• Bleeding or bruising
• Shortness of breath
• Anemia
• Night sweat
• Decrease in appetite
• Skin rash or itching
• Joint or bone pain

Some people with CMML may also develop complications such as acute leukemia, which is a more aggressive form of blood cancer.

These symptoms can be caused by many different conditions, so they don’t necessarily mean you have CMML. However, if you’re experiencing any of these symptoms or are at risk for CMML, talk to your doctor about getting tested. Early diagnosis and treatment can help improve your outlook and quality of life.

Diagnosis and Tests

The diagnosis of chronic myelomonocytic leukemia (CMML) typically involves a combination of medical history, physical examination, and laboratory tests. Here are some of the common tests used for diagnosis –

1. Complete blood count (CBC) – A CBC is a blood test that measures the number and types of blood cells in the body. In CMML, the CBC typically shows an increase in monocytes and other abnormalities in the blood cells.
2. Bone marrow biopsy – A bone marrow biopsy involves removing a small sample of bone marrow from the hipbone or breastbone and examining it under a microscope. This test can help diagnose CMML and determine the stage of the disease.
3. Cytogenetic testing – Cytogenetic testing involves analyzing the chromosomes in the cells of the bone marrow. In CMML, this test can reveal chromosome abnormalities that may help diagnose the disease and predict how it will progress.
4. Molecular testing – Molecular testing looks for specific genetic mutations that may be present in the cells of the bone marrow. This test can help diagnose CMML and determine the best treatment options.
5. Flow cytometry – Flow cytometry is a laboratory technique that uses antibodies to identify and analyze the different types of cells in the blood and bone marrow. In CMML, this test can help identify abnormal cells and determine the stage of the disease.
6. Imaging tests –  Imaging tests, such as X-rays, CT scans, and MRI scans, may be used to detect any tumors or other abnormalities in the body that may be related to CMML.

The results of these tests can help doctors diagnose and determine the best treatment options. If you have symptoms of CMML or are at risk for the disease, talk to your doctor about getting tested. Early diagnosis and treatment can help improve your outlook and quality of life.

Treatments

The treatment for chronic myelomonocytic leukemia (CMML) depends on the stage of the disease, the age and overall health of the patient, and other factors. The main treatment options for CMML include –

1. Chemotherapy – Chemotherapy is a treatment that uses drugs to kill cancer cells. It may be used to treat CMML, particularly in people with advanced or rapidly progressing diseases.
2. Stem cell transplant – A stem cell transplant involves replacing the patient’s bone marrow with healthy stem cells from a donor. This treatment can be curative for some people with CMML, particularly those who are younger and have a compatible donor.
3. Targeted therapy – Targeted therapy is a newer type of treatment that uses drugs to target specific proteins or genes that play a role in the growth and spread of cancer cells. Some targeted therapies may be effective for treating CMML.
4. Supportive care – Supportive care includes treatments and therapies that help manage the symptoms and complications of CMML, such as blood transfusions, antibiotics to prevent infections, and medications to manage pain.

Clinical trials

Clinical trials are studies that test new treatments or combinations of treatments for CMML. Participating in a clinical trial may be an option for some people with the disease. It helps to improve a patient’s life, extend survival rate, and provide high-quality treatment. It also helps doctors determine the safety and efficacy of new treatments to make them available for all.