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Published in: memo - Magazine of European Medical Oncology 4/2016

01-12-2016 | short review

Treatment of chronic myelomonocytic leukemia

Author: Sonja Burgstaller, MD

Published in: memo - Magazine of European Medical Oncology | Issue 4/2016

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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.
Literature
1.
go back to reference 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. 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.
2.
go back to reference 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.CrossRef 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.CrossRef
3.
go back to reference 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.CrossRef 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.CrossRef
4.
go back to reference 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.CrossRef 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.CrossRef
5.
go back to reference 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.CrossRef 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.CrossRef
6.
go back to reference Storniolo AM, Moloney WC, Rosenthal DS, Cox C, Bennett JM. Chronic myelomonocytic leukemia. Leukemia. 1990;4:766–70.PubMed Storniolo AM, Moloney WC, Rosenthal DS, Cox C, Bennett JM. Chronic myelomonocytic leukemia. Leukemia. 1990;4:766–70.PubMed
7.
go back to reference 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.CrossRef 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.CrossRef
8.
go back to reference 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.CrossRef 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.CrossRef
9.
go back to reference 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.CrossRef 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.CrossRef
11.
go back to reference 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.CrossRef 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.CrossRef
12.
go back to reference 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.CrossRef 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.CrossRef
13.
go back to reference 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.PubMed 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.PubMed
14.
go back to reference 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.CrossRef 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.CrossRef
15.
go back to reference 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.CrossRef 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.CrossRef
16.
go back to reference 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.CrossRef 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.CrossRef
17.
go back to reference 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.CrossRef 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.CrossRef
18.
go back to reference 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.CrossRef 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.CrossRef
19.
go back to reference 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.CrossRef 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.CrossRef
20.
go back to reference 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.CrossRef 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.CrossRef
21.
go back to reference 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.CrossRef 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.CrossRef
22.
go back to reference 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.CrossRef 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.CrossRef
23.
go back to reference 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.CrossRef 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.CrossRef
24.
go back to reference 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.CrossRef 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.CrossRef
25.
go back to reference 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.CrossRef 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.CrossRef
26.
go back to reference 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.CrossRef 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.CrossRef
27.
go back to reference 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.CrossRef 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.CrossRef
28.
go back to reference 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.CrossRef 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.CrossRef
29.
go back to reference 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.CrossRef 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.CrossRef
Metadata
Title
Treatment of chronic myelomonocytic leukemia
Author
Sonja Burgstaller, MD
Publication date
01-12-2016
Publisher
Springer Vienna
Published in
memo - Magazine of European Medical Oncology / Issue 4/2016
Print ISSN: 1865-5041
Electronic ISSN: 1865-5076
DOI
https://doi.org/10.1007/s12254-016-0291-3

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