|
Table of Contents General Information About Myelodysplastic/Myeloproliferative Diseases
Chronic Myelomonocytic Leukemia
Juvenile Myelomonocytic Leukemia
Atypical Chronic Myelogenous Leukemia
Myelodysplastic/Myeloproliferative Disease, Unclassifiable
Stages of Myelodysplastic/Myeloproliferative Diseases
Treatment Option Overview
Treatment Options for Myelodysplastic/Myeloproliferative Diseases
To Learn More About Myelodysplastic/Myeloproliferative Diseases
Get More Information From NCI
Changes to This Summary (08/01/2008)
About PDQ
General Information About Myelodysplastic/Myeloproliferative Diseases
| Key Points for This Section
|
|
Myelodysplastic/myeloproliferative diseases are a group of diseases in which the bone marrow makes too many white blood cells.
Myelodysplastic /myeloproliferative diseases are diseases of the blood and bone marrow. Normally, the bone marrow makes blood stem cells (immature cells) that become mature blood cells over time. A blood stem cell may become a myeloid stem cell or a lymphoid stem cell. The lymphoid stem cell develops into a white blood cell. The myeloid stem cell develops into one of three types of mature blood cells:
|
Enlarge
|
|
|
|
|
| Blood cell development. A blood stem cell goes through several steps to become a red blood cell, platelet, or white blood cell. |
Myelodysplastic/myeloproliferative diseases have features of both myelodysplastic syndromes and myeloproliferative disorders.
In myelodysplastic diseases, the blood stem cells do not mature into healthy red blood cells, white blood cells, or platelets. The immature blood cells, called blasts, do not work the way they should and die in the bone marrow or soon after they enter the blood. As a result, there are fewer healthy red blood cells, white blood cells, and platelets.
In myeloproliferative diseases, a greater than normal number of blood stem cells develop into one or more types of blood cells and the total number of blood cells slowly increases.
This summary is about diseases that have features of both myelodysplastic and myeloproliferative diseases. See the following PDQ summaries for more information about related diseases:
There are different types of myelodysplastic/myeloproliferative diseases.
The 3 main types of myelodysplastic/myeloproliferative disease include the following:
When a myelodysplastic/myeloproliferative disease does not match any of these types, it is called myelodysplastic/myeloproliferative disease, unclassifiable (MDS/MPD-UC).
Myelodysplastic/myeloproliferative diseases may progress to acute leukemia.
Tests that examine the blood and bone marrow are used to detect (find) and diagnose myelodysplastic/myeloproliferative diseases.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease such as an enlarged spleen and liver. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Complete blood count (CBC) with differential: A procedure in which a sample of blood is drawn and checked for the following:
- The number of red blood cells and platelets.
- The number and type of white blood cells.
- The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
- The portion of the sample made up of red blood cells.
| Enlarge | | | | Complete blood count (CBC). Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets are counted. The CBC is used to test for, diagnose, and monitor many different conditions. |
- Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.
- Peripheral blood smear: A procedure in which a sample of blood is checked for the presence of blast cells, number and kinds of white blood cells, the number of platelets, and changes in the shape of blood cells.
- Cytogenetic analysis: A test in which cells in a sample of blood or bone marrow are viewed under a microscope to look for certain changes in the chromosomes.
The cancer cells in myelodysplastic/myeloproliferative diseases do not contain the Philadelphia chromosome that is present in chronic myelogenous leukemia.
- Bone marrow aspiration and biopsy: The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views both the bone and bone marrow samples under a microscope to look for abnormal cells.
| Enlarge | | | | Bone marrow aspiration and biopsy. After a small area of skin is numbed, a Jamshidi needle (a long, hollow needle) is inserted into the patient’s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope. |
Back to Top Chronic Myelomonocytic Leukemia
| Key Points for This Section
|
|
|
Chronic myelomonocytic leukemia is a disease in which too many myelocytes and monocytes (immature white blood cells) are made in the bone marrow.
In CMML, the body tells too many blood stem cells to develop into two types of white blood cells called myelocytes and monocytes. Some of these blood stem cells never become mature white blood cells. These immature white blood cells are called blasts. Over time, the myelocytes, monocytes, and blasts crowd out the red blood cells and platelets in the bone marrow. When this happens, infection, anemia, or easy bleeding may occur.
Older age and being male increase the risk of developing chronic myelomonocytic leukemia.
Anything that increases your chance of getting a disease is called a risk factor. Possible risk factors for CMML include the following:
- Older age.
- Being male.
- Being exposed to certain substances at work or in the environment.
- Being exposed to radiation.
- Past treatment with certain anticancer drugs.
Possible signs of chronic myelomonocytic leukemia include fever, feeling very tired, and weight loss.
These and other symptoms may be caused by CMML. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
- Fever for no known reason.
- Infection.
- Feeling very tired.
- Weight loss for no known reason.
- Easy bruising or bleeding.
- Pain or a feeling of fullness below the ribs.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options for CMML depend on the following:
- The number of white blood cells or platelets in the blood or bone marrow.
- Whether the patient is anemic.
- The amount of blasts in the blood or bone marrow.
- The amount of hemoglobin in red blood cells.
- Whether there are certain changes in the chromosomes.
Back to Top Juvenile Myelomonocytic Leukemia
| Key Points for This Section
|
|
|
Juvenile myelomonocytic leukemia is a childhood disease in which too many myelocytes and monocytes (immature white blood cells) are made in the bone marrow.
Juvenile myelomonocytic leukemia is a rare childhood cancer that occurs more often in children younger than 2 years. Children who have neurofibromatosis type 1 and males have an increased risk of developing juvenile myelomonocytic leukemia.
In JMML, the body tells too many blood stem cells to develop into two types of white blood cells called myelocytes and monocytes. Some of these blood stem cells never become mature white blood cells. These immature white blood cells are called blasts. Over time, the myelocytes, monocytes, and blasts crowd out the red blood cells and platelets in the bone marrow. When this happens, infection, anemia, or easy bleeding may occur.
Possible signs of juvenile myelomonocytic leukemia include fever, feeling very tired, and weight loss.
These and other symptoms may be caused by JMML. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
- Fever for no known reason.
- Having infections, such as bronchitis or tonsillitis.
- Feeling very tired.
- Easy bruising or bleeding.
- Skin rash.
- Painless swelling of the lymph nodes in the neck, underarm, stomach, or groin.
- Pain or a feeling of fullness below the ribs.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options for JMML depend on the following:
- The age of the child at diagnosis.
- The number of platelets in the blood.
- The amount of a certain type of hemoglobin in red blood cells.
Back to Top Atypical Chronic Myelogenous Leukemia
| Key Points for This Section
|
|
|
Atypical chronic myelogenous leukemia is a disease in which too many granulocytes (immature white blood cells) are made in the bone marrow.
In atypical chronic myelogenous leukemia (aCML), the body tells too many blood stem cells to develop into a type of white blood cell called granulocytes. Some of these blood stem cells never become mature white blood cells. These immature white blood cells are called blasts. Over time, the granulocytes and blasts crowd out the red blood cells and platelets in the bone marrow.
The leukemia cells in aCML and chronic myelogenous leukemia (CML) look alike under a microscope. However, in aCML a certain chromosome change, called the "Philadelphia chromosome" is not present.
Possible signs of atypical chronic myelogenous leukemia include easy bruising or bleeding and feeling tired and weak.
These and other symptoms may be caused by aCML. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
- Shortness of breath.
- Pale skin.
- Feeling very tired and weak.
- Easy bruising or bleeding.
- Petechiae (flat, pinpoint spots under the skin caused by bleeding).
- Pain or a feeling of fullness below the ribs on the left side.
Certain factors affect prognosis (chance of recovery).
The prognosis (chance of recovery) for aCML depends on the number of red blood cells and platelets in the blood.
Back to Top Myelodysplastic/Myeloproliferative Disease, Unclassifiable
| Key Points for This Section
|
|
|
Myelodysplastic/myeloproliferative disease, unclassifiable, is a disease that has features of both myelodysplastic and myeloproliferative diseases but is not chronic myelomonocytic leukemia, juvenile myelomonocytic leukemia, or atypical chronic myelogenous leukemia.
In myelodysplastic /myeloproliferative disease, unclassifiable (MDS/MPD-UC), the body tells too many blood stem cells to develop into red blood cells, white blood cells, or platelets. Some of these blood stem cells never become mature blood cells. These immature blood cells are called blasts. Over time, the abnormal blood cells and blasts in the bone marrow crowd out the healthy red blood cells, white blood cells, and platelets.
MDS/MPD-UC is a very rare disease. Because it is so rare, the factors that affect risk and prognosis are not known.
Possible signs of chronic myelomonocytic leukemia include fever, feeling very tired, and weight loss.
These and other symptoms may be caused by MDS/MPD-UC. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
- Fever or frequent infections.
- Shortness of breath.
- Feeling very tired and weak.
- Pale skin.
- Easy bruising or bleeding.
- Petechiae (flat, pinpoint spots under the skin caused by bleeding).
- Pain or a feeling of fullness below the ribs.
Back to Top Stages of Myelodysplastic/Myeloproliferative Diseases
| Key Points for This Section
|
|
|
There is no standard staging system for myelodysplastic/myeloproliferative diseases.
Staging is the process used to find out how far the cancer has spread. There is no standard staging system for myelodysplastic /myeloproliferative diseases. Treatment is based on the type of myelodysplastic/myeloproliferative disease the patient has. It is important to know the type in order to plan treatment.
There are three ways that cancer spreads in the body.
When cancer cells spread outside the blood, a solid tumor may form. This process is called metastasis.
The three ways that cancer cells spread in the body are:
- Through the blood. Cancer cells travel through the blood, invade solid tissues in the body, such as the brain or heart, and form a solid tumor.
- Through the lymph system. Cancer cells invade the lymph system, travel through the lymph vessels, and form a solid tumor in other parts of the body.
- Through solid tissue. Cancer cells that have formed a solid tumor spread to tissues in the surrounding area.
The new (metastatic) tumor is the same type of cancer as the primary cancer. For example, if leukemia cells spread to the brain, the cancer cells in the brain are actually leukemia cells. The disease is metastatic leukemia, not brain cancer.
Back to Top Treatment Option Overview
| Key Points for This Section
|
|
|
There are different types of treatment for patients with myelodysplastic/myeloproliferative diseases.
Different types of treatments are available for patients with myelodysplastic /myeloproliferative diseases. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Four types of standard treatment are used:
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. Combination chemotherapy is treatment using more than one anticancer drug.
Other drug therapy
13-cis retinoic acid is a vitamin -like drug that slows the cancer's ability to make more cancer cells and changes the way these cells look and act.
Stem cell transplant
Stem cell transplant is a method of replacing blood -forming cells that are destroyed by chemotherapy. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.
Supportive care
Supportive care is given to lessen the problems caused by the disease or its treatment. Supportive care may include transfusion therapy or drug therapy, such as antibiotics to fight infection.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
Targeted therapy
Targeted therapy is a cancer treatment that uses drugs or other substances to attack cancer cells without harming normal cells. Farnesyltransferase inhibitors are one type of targeted therapy that is being studied in the treatment of JMML.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Back to Top Treatment Options for Myelodysplastic/Myeloproliferative Diseases
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Chronic Myelomonocytic Leukemia
Treatment of chronic myelomonocytic leukemia (CMML) may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with chronic myelomonocytic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Juvenile Myelomonocytic Leukemia
Treatment of juvenile myelomonocytic leukemia (JMML) may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with juvenile myelomonocytic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Atypical Chronic Myelogenous Leukemia
Treatment of atypical chronic myelogenous leukemia (aCML) may include chemotherapy.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with atypical chronic myeloid leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Myelodysplastic/Myeloproliferative Disease, Unclassifiable
Because myelodysplastic /myeloproliferative disease, unclassifiable (MDS/MPD-UC) is a rare disease, little is known about its treatment. Supportive care treatments are used to manage problems caused by the disease such as infection, bleeding, and anemia.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with myelodysplastic/myeloproliferative disease, unclassifiable. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Back to Top To Learn More About Myelodysplastic/Myeloproliferative Diseases
For more information from the National Cancer Institute about myelodysplastic/myeloproliferative diseases, see the following:
For general cancer information and other resources from the National Cancer Institute, see the following:
Back to Top Get More Information From NCI
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
Chat online
The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
- NCI Public Inquiries Office
- Suite 3036A
- 6116 Executive Boulevard, MSC8322
- Bethesda, MD 20892-8322
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
Find Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
Back to Top Changes to This Summary (08/01/2008)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Text describing the way cancer spreads in the body was added to the Stages section.
Back to Top About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
Back to Top |
)
. Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets are counted. The CBC is used to test for, diagnose, and monitor many different conditions.','popup','width=780,height=630,scrollbars=1,resizable=1,menubar=0,location=0,status=0,toolbar=0'))
 is inserted into the patient\'s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.','popup','width=780,height=630,scrollbars=1,resizable=1,menubar=0,location=0,status=0,toolbar=0'))