Chronic Myelomonocytic Leukaemia (CMML) is a type of cancer of the blood-forming cells of the bone marrow. In CMML, there are increased numbers of monocytes and immature blood cells in the peripheral blood and bone marrow.

Signs and Symptoms

• The most common sign of Chronic Myelomonocytic Leukemia (CMML) is excessive monocytes 
• Monocytes can settle in the spleen or liver, enlarging these organs. Thus, Splenomegaly and hepatomegaly are often present.
• Anemia due to less red blood count causing fatigue, shortness of breath and pale skin.
• Low white blood cells leading to frequent infections.
• Shortage of blood platelets can lead to easy bruising and bleeding.

Risk factors for CMML

• Age: The risk of CMML increases with age. 
• Sex: CMML is about twice as common in men as in women.
• Cancer treatment: Prior treatment with chemotherapy seems to increase the risk of CMML. 

Diagnosis of CMML

Diagnosis is a based on test results from blood and bone marrow:

• Blood test: People with CMML have higher numbers of monocytes, less of red blood cells and blood platelets.Some patients also have a small number of monoblasts in the blood. 
• Bone Marrow analysis: Bone marrow samples are taken by bone marrow aspiration and biopsy for testing. The pathologist studies the type and number of blood-forming cells in the bone marrow aspirate and biopsy, also examines the size and shape of the cells.
• Measuring blasts: This is very important. Blasts are very early (immature) cells that are made by bone marrow stem cells, blasts mature into normal blood cells. In CMML, some of the blasts do not mature properly, so there may be too many blasts and not enough mature cells. 
• Cytogenetic tests: This is a study of chromosomes inside the cells. Chromosome changes or abnormalities are common in CMML. Chromosome testing also helps to differentiate between chronic myeloid leukemia or CML. Results of Cytogenetic testing can take several weeks 
• Immunocytochemistry: It is helpful in distinguishing CMML from other types of leukemia and from other diseases.

Treatment of CMML

Treatment of Chronic Myelomonocytic Leukemia (CMML) is based on staging of the disease, as well as the patient’s age and general health. Treatment for CMML may include:

• Chemotherapy

It is the usage of drugs for the treatment of disease. Chemo cannot cure CMML, but it can help kill the abnormal bone marrow cells and allowing normal ones to grow back. Chemotherapy drugs enter the bloodstream and can reach most areas of the body. Common side effects of chemo include:

• Fatigue 
• Low blood counts 
• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting

• Growth Factors

Hematopoietic growth factors are hormone-like substances that stimulate the bone marrow to produce blood cells. Growth factor drugs are usually given by subcutaneous injections and help keep blood counts at normal levels.

• Radiotherapy

Radiation therapy is a treatment with high-energy rays or particles to kill cancer cells. The most common form of radiation therapy is external beam radiation therapy. Radiotherapy can also be useful to shrink an enlarged spleen. 

• Stem Cell Transplant (SCT)

Stem Cell Transplant is the only treatment that can cure Chronic Myelomonocytic Leukemia (CMML). Here the cells in the bone marrow are destroyed with chemotherapy along with radiotherapy, and then the patient is given new, healthy blood-forming stem cells.

• Supportive Treatment for CMML 

Chronic Myelomonocytic Leukemia (CMML) can be difficult to cure, many times the main goal is to prevent the problems caused by CMML. For e.g.,

• Low red blood cell counts can cause severe fatigue. Treating with blood transfusions and/or erythropoietin can help patients. 
• CMML patients with bleeding problems due to low platelets may benefit from platelet transfusions.
• People with CMML tend to get infections very easily, any suspected infections should be treated with antibiotics.

After Treatment

CMML is difficult to cure; it may never go away completely, so regular follow-up is very important. Blood tests and imaging tests on the regular basis are important. 

Factors affecting the Cost of Treatment of CMML

The cost to the patient depends on a variety of factors like:

• The hospital patient chooses
• The type of room
• Fees for the team of doctors
• Medicine cost
• Cost of Tests and diagnostic procedure
• Type of treatment -Cost of stem cell transplant, cost of radiotherapy, cost of chemotherapy
• Cost of follow -up care required.