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Chronic myelomonocytic leukemia is a rare cancer with features that overlap both myelodysplastic syndromes and myeloproliferative neoplasms.??

But what distinguishes this particular type of leukemia from others? How do its symptoms differ? And, is it curable? Read on for the answers to these questions and more.?

What makes chronic myelomonocytic leukemia unique??

Chronic myelomonocytic leukemia is not a single entity. It¡¯s more like a group of diseases. That¡¯s why it shares features with both myelodysplastic syndrome and myeloproliferative neoplasms. All of these are chronic bone marrow disorders that affect stem cells.??

Here¡¯s how I usually explain them to my patients:?

Myelodysplastic syndrome (MDS)

Genetic errors prevent stem cells from maturing properly, so they look abnormal under a microscope and patients tend to have low white blood cell counts, hemoglobin values or platelet counts.?

Myeloproliferative neoplasms (MPN)

Genetic errors cause bone marrow to overproduce different types of blood cells, such as red blood cells in polycythemia vera or platelets in essential thrombocythemia. In other cases, myelofibrosis, which is scarring of the bone marrow, can develop.?

Chronic myelomonocytic leukemia (CMML)

Genetic errors in stem cells can simultaneously reduce the bone marrow¡¯s ability to produce normal levels of red blood cells or platelets, causing low blood counts, and over-produce white blood cells. In CMML, there is a significant increase in a unique type of white blood cell called monocytes. Because of these overlapping aspects, in cases where CMML shows more of the low counts without white blood cell increase, the disease is called myelodysplastic. On the other hand, if CMML causes an elevation in white blood cells, it is called myeloproliferative.?

Keep in mind that chronic myelomonocytic leukemia is very rare. It is most common among the elderly, and typically occurs between ages 68 and 70. About 60% of those diagnoses occur in men.?

What are the earliest signs of chronic myelomonocytic leukemia??

Chronic myelomonocytic leukemia is usually found through abnormalities in routine bloodwork. Someone might discover they have anemia during an annual physical, for instance, or their monocyte count may be consistently elevated, and that will lead to a diagnosis.??

Chronic myelomonocytic leukemia is also associated with various rheumatologic disorders, including rheumatoid arthritis and lupus. These can mimic the symptoms of CMML. So, sometimes, it is found that way, when someone seeks treatment for one of those diseases.?

How do the symptoms of chronic myelomonocytic leukemia differ from others?

Because CMML is not a single entity and occurs on a spectrum, how the disease looks in a particular individual depends entirely on what type of CMML a patient has. And that is determined by the type of mutations that led to the disease emerging.??

Patients whose blood counts are low, for instance, might show no symptoms at all for several years, or only those associated with low blood counts, such as fatigue, anemia or bruising easily. Patients with more proliferative features, on the other hand, might have an enlarged spleen and show more ¡°B symptoms,¡± such as night sweats, weight loss, fevers, or skin rashes.??

Symptoms can vary greatly, depending on the person. That¡¯s why it¡¯s so important to see a specialist at a place like MD Anderson, which does research on this disease.??

CMML is very rare. But how it¡¯s managed can differ quite dramatically, depending on your symptoms and whether the disease is considered high-risk or low-risk. Some patients only need observation, while others need an immediate allogeneic stem cell transplant or a clinical trial using new drugs or drug combinations. The possibilities are very broad.?

What are the final stages of chronic myelomonocytic leukemia??

With time, chronic myelomonocytic leukemia can potentially evolve in one of three ways.??

• Bone marrow failure: This requires repeated blood transfusions and makes infections more likely. People with bone marrow failure usually die from complications of chronically low blood counts.?
• Transformation into acute myeloid leukemia: Once this happens, the disease becomes more aggressive, and an allogeneic stem cell transplant should always be considered.?
• Unrelated complications: These are considered a result of the disease, but not necessarily a feature of the disease. Examples include heart or kidney failure.?

Unfortunately, there are no approved and effective standard treatments for any of these scenarios. That¡¯s why seeking care in centers where clinical trials are available becomes critical. Research directed at understanding how CMML occurs and progresses continues to expand rapidly, thanks to academic centers like MD Anderson. This is helping us develop novel clinical trials.?

What¡¯s the average life expectancy for someone with chronic myelomonocytic leukemia?

That depends on the person. Everyone is different. It can range from a median of 1.5 years after diagnosis up to about 8 years. More aggressive variations of the disease will require more involved and prompt treatments. With slower-moving variations, often we can just monitor patients and treat their symptoms.?

Is chronic myelomonocytic leukemia curable??

The only potentially curative treatment for chronic myelomonocytic leukemia right now is an allogeneic stem cell transplant. Although its success rate is not 100%, it is currently the best option we have and can lead to good results.?

That¡¯s why we¡¯re exploring different treatments through clinical trials. We have several underway right now that target this disease specifically. One involves a new drug called STX-0712 that uses the immune system to kill CMML cells. Others combine decitabine or azacitidine with new drugs that affect the ways leukemia cells mature, such as seclidemstat or EP36170. Other treatments rely on new chemotherapies to kill the leukemia cells.??

Because CMML is so rare and the way it behaves can vary so greatly, we are trying to approach the disease from many different angles. That¡¯s why every patient with CMML would benefit from seeing a specialist at a facility that does research, like MD Anderson. Treatment options are already so limited for CMML that expertise is required to fully understand your disease and give you the best possible outcome.?

, is a leukemia specialist with a particular interest in chronic myelomonocytic leukemia.??

or call 1-877-632-6789.

How many types of leukemia are there? What makes each one unique, and are they treated any differently??

We went to leukemia specialist for answers to these questions and more. Here¡¯s what he shared.?

How many different types of leukemia are there?

Quite a few. Leukemia is not just a single disease. It¡¯s actually a diverse group of blood-based cancers that originate in the bone marrow.??

All leukemias fall into one of two major categories: acute or chronic.??

• Acute leukemias are blood cancers that generally appear suddenly or over a very short period of time. The classic scenario is someone who was just fine at their annual physical, but is diagnosed with leukemia a few months later.?
  
  
• Chronic leukemias generally develop much more slowly, so they¡¯re usually found in one of two ways: either a young patient is being evaluated for something else, or an older patient is having problems with recurrent infections, bleeding or abnormal lab work.??

Examples of younger patients¡¯ situations might include an athlete getting lab work done before having knee surgery, or a person having blood tests done in order to obtain a new life insurance policy. Young patients with chronic leukemia often have no symptoms, so they tend to be diagnosed unexpectedly.?

Is leukemia broken down any further, beyond those two categories?

Yes. They¡¯re further subtyped by the kind of white blood cell involved: either myeloid or lymphocyctic. The four main types of leukemia are:?

• Acute myeloid leukemia (AML) is most commonly diagnosed among people in their 60s and 70s. It only affects about 21,000 people a year, but it¡¯s among the most aggressive of all cancers. Still, there is much cause for hope. Because we can now subdivide these cancers in a way that we previously couldn¡¯t, using molecular markers, protein receptors and other attributes. This allows us to treat them using personalized targeted therapy. And there¡¯s been a ton of progress in this area over the last five years or so, with much of it led by our own along with ., and These cancers may also be treated with chemotherapy, stem cell transplants or immunotherapy. We have a large number of clinical trials available as well.
  
  
• Acute lymphocytic leukemia (ALL) is most common among children, though adults can develop it, too. It¡¯s a fairly rare cancer, affecting fewer than 10,000 people a year. At MD Anderson, we¡¯ve developed highly curable regimens for this disease, under the guidance of and Some patients don¡¯t even need a stem cell transplant to get long-term results. The type of blood cell involved (T-cell or B-cell) determines the treatment, which could be a combination of chemotherapy, immunotherapy, or targeted therapy.??
  
  
• Chronic myeloid leukemia (CML) is extremely rare, with only several thousand diagnoses each year. All patients with CML will have the Philadelphia chromosome translocation, making their leukemia ¡°Philadelphia-positive.¡± Historically, this has been a very deadly disease, with median survival rates of only 5 to 7 years after diagnosis. But now, with tyrosine kinase inhibitors like imatinib, dasatinib, nilotinib, ponatinib, and bosutinib, we¡¯re seeing patients going into complete molecular remission over time. This is one area in which oral targeted therapy has really revolutionized the lives of many leukemia patients.?
  
  
• Chronic lymphocytic leukemia (CLL) is one of the most common leukemias among adults. Previously, CLL patients had to be treated with intravenous chemotherapies. Today, oral targeted therapy agents, including BTK inhibitors and venetoclax, have been showing a lot of promise. And the vast majority of patients with this disease can now take oral chemotherapy as a part of their treatment regimens, instead of just IV-based drugs. . and . have been pioneering this combination-therapy approach here.??

What is Philadelphia-positive leukemia?

Philadelphia-positive leukemia is characterized by the translocation of chromosomes 9 and 22. This happens when a part of chromosome 9 breaks off and attaches itself to chromosome 22, which results in the generation of abnormal cells.

Philadelphia-positive was one of the first types of leukemia to prove amenable to oral chemotherapy, and the leukemia team here at MD Anderson was the first to combine that approach with immunotherapy, which has led to some very high cure rates.?Interestingly, the Philadelphia chromosome occurs in 100% of CML cases, but it¡¯s also present to a lesser extent in AML and ALL.?

What are the other types of leukemia that people should know about?

• Myelodysplastic syndrome (MDS): This used to be called ¡°pre-leukemia,¡± because it could sometimes lead to leukemia. But today, doctors understand it as a unique blood cancer in and of itself. It happens when the bone marrow produces too many immature blood cells, causing a shortage of platelets, a condition known as thrombocytopenia. MDS can be life-threatening and requires its own separate approach. is leading our investigation in this field.
  
  
• Myeloproliferative neoplasms (MPN): This used to be called myeloproliferative disorder (MPD), but various discoveries led to a better understanding of it as a family of blood cancers in and of itself, so it was renamed. MPN is usually treated with oral chemotherapy, but our is the worldwide leader in this field, and several of his clinical trials are exploring combination treatments.?
  
  
• Aplastic anemia: This is a stem cell disorder caused by bone marrow failure. It is typically treated with a combination of chemo and immunotherapy. Our leader in this area, Dr. Kadia, has been conducting clinical trials that address the unique aspects of this disease.
  
  
• Blastic plasmacytoid dendritic cell neoplasm (BPDCN): This was originally thought to be a type of lymphoma, but now it¡¯s considered its own subtype of leukemia/dendritic cell cancer. BPDCN results from an overexpression of the CD123 protein. It usually appears as a skin disorder, which is quite uncommon, but our group developed the first ¡ª and so far, only ¡ª drug to be approved by the Food and Drug Administration?(FDA) to treat it: tagraxofusp-erzs.
  
  
• Hairy cell leukemia: This is a rare form of chronic leukemia that only affects about 1,000 people a year. We¡¯ve had a lot of success in treating it with a combination of rituximab and cladribine that was pioneered here under Dr. Ravandi.
  
  
• Chronic Myelomonocytic Leukemia (CMML): This has now been recognized as it is own subtype in the MDS/MPN area, and is an emerging field of scientific breakthroughs through clinical trials, led here by

What¡¯s the one thing you want people to know about leukemia treatment right now?

Some of these leukemia types are either rare or ultra-rare, but each one has developed its own field of study due to various discoveries. Many patients can live for decades now with some of these subtypes, thanks to our personalized approach to treatment. And our common goal among all of these diseases is to maximize patients¡¯ response to treatment while also improving their quality of life.?

or by calling 1-877-632-6789.

Acute myeloid leukemia (AML) is a cancer of the blood and bone marrow. ¡°Acute¡± means that this leukemia can progress rapidly if not treated, and ¡°myeloid¡± refers to the type of cell this leukemia starts from.

While AML typically occurs in adults with median age of 67, MD Anderson does treat many adolescent and young adult AML patients.?

If you or a loved one has been diagnosed with AML, you have many questions. We spoke with to get answers to some common questions he hears about AML.

What is leukemia?

Leukemia is the name for a very large, complex, diverse group of malignant tumors that arise from the bone marrow and involve the blood.?

Can you explain the different types of leukemia??

Leukemias are grouped by the type of cell affected and the rate of cell growth.

Acute leukemia involves an overgrowth of very immature blood cells. There are two main types of?acute leukemia:

• Acute lymphocyte leukemia (ALL)
• Acute myeloid (or myelogenous) leukemia (AML)

Chronic leukemia involves an overgrowth of mature blood cells. The main types of chronic leukemia are:

• Chronic lymphoblastic leukemia (CLL)
• Chronic myeloid (or myelogenous) leukemia (CML)?

We also treat many patients with other subtypes of leukemia, such as myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPN), aplastic anemia, blastic plasmacytoid dendritic cell neoplasm (BPDCN) and hairy cell leukemia.?

What are the symptoms of AML??

There is generally a wide range of symptoms and presentations. Some patients may not have many symptoms and may only be diagnosed through blood testing when presenting in the clinic, through the emergency room, or in the hospital.

Others may experience common symptoms, such as fatigue, fevers/infections, bleeding and easy bruising. Some patients may be so ill that they present directly through the emergency room to the intensive care unit.

Are some people more likely to develop AML?

The exact cause of AML is unknown.?Some associations/risk factors include:

• Exposure to ionizing radiation or specific chemical exposure
• Certain genetic/familial syndromes, such as familial platelet disorders with propensity to myeloid malignancies or inherited bone marrow failure syndromes
• Prior cancer treatment with either radiation or chemotherapy
• Patients with antecedent hematologic malignancy, such as MDS, MPN, aplastic anemia, BPDCN

How is AML typically treated?

Unfortunately, there¡¯s not yet a reliable, standard therapy for most patients with AML. Many patients undergo chemotherapy and/or a stem cell transplant, which is a procedure that replaces defective or damaged cells in patients whose normal blood cells have been affected by cancer.

But stem cell transplants often aren¡¯t an option for patients older than age 70, and some of the most common intensive chemotherapy regimens used for patients at younger ages may not work for all older patients. Often the best options may include a clinical trial.?

What clinical trials is MD Anderson offering for older AML patients?

At MD Anderson, we have a number of different AML clinical trials, some of which are part of our . Some of the frontline AML clinical trials we have for older patients include:

• A hypomethylator agent (such as Azacytidine, Decitabine or SGI-110) alone or with?another agent
• Novel clinical trial drugs alone or in combinations, including targeted therapies based on a particular patient¡¯s mutational profile (FLT3, IDH 1 or 2, or CD123, for example)
• Immunotherapy agents or immunotherapy in combination with chemotherapy

What other new research is on the horizon for AML??

Besides the clinical trials I just mentioned, we¡¯ll soon be looking at targeted therapy agents aimed at a particular molecular mutation or aberrant molecular pathways

Other approaches will soon include newer forms of immunotherapy, such as chimeric antigen receptor (CAR) T-cell therapy, bi-specific antibody therapies and others via upcoming clinical trials.

Why are patients with acute leukemia at increased risk of infection??

If the white blood cell count, specifically the neutrophil count, is very low, this can weaken the immune system¡¯s functioning and make it harder for a patient to fight off infections.

This can happen because of the leukemia itself or as a result of the cancer treatment. Generally, patients in active therapy may be placed on preventive antibiotics to help protect against some of the more common infections.

What¡¯s your advice for newly diagnosed AML patients??

Every patient is unique and each patient should have a serious conversation with their oncologist when diagnosed with AML. It¡¯s important that you receive treatment from someone with a lot of experience treating AML and who has access to the latest clinical trials. I encourage new AML patients to schedule an appointment with an experienced hematologist at a comprehensive cancer center such as?MD Anderson.

I also recommend finding out about your clinical trial options upfront, whether you have a new AML diagnosis or you have relapsed AML.