Have you ever heard of a disease called `CMML` or Chronic Myelomonocytic Leukemia ? Probably not. Because it is a rare type of blood cancer. But it is very important for us to be aware of this. Because it affects the way our body makes blood. Let's talk about this simply, in a way that you can understand.
What is CMML? Let's understand it simply!
Simply put, your bone marrow – the spongy part inside your bones – is what makes blood. A person with CMML has an abnormally high production of a type of white blood cell called monocytes . These abnormal monocytes crowd out the healthy red blood cells , platelets , and other healthy white blood cells that we need. Think of it like weeds in a garden crowding out healthy trees.
Doctors classify this condition as Myeloproliferative neoplasm/Myelodysplastic syndrome (MPN/ MDS ). While this may seem like a complicated combination of words, it actually means:
- Myeloproliferative neoplasm (MPN): This is when your bone marrow makes too many of one type of blood cell. When too much of just one type is produced, the balance of the blood is disrupted and the blood does not function properly.
- Myelodysplastic syndrome (MDS): This is a condition in which the blood cells produced by your bone marrow become abnormal and misshapen . Specifically, instead of healthy, mature blood cells, they produce more immature cells called blast cells.
CMML can sometimes grow very slowly. But sometimes it can be a little faster and more severe. Your doctor will explain to you about treatments that can control its growth.
What are the symptoms of CMML? Do you have these too?
Symptoms of CMML are not always obvious. Sometimes a blood test is the first clue. Even when symptoms do appear, they usually come on gradually. See if these symptoms sound familiar to you:
- Feeling tired and weak all the time: This is due to a decrease in red blood cells, which is anemia .
- Frequent illness and infections: This is due to a decrease in white blood cells, which is called neutropenia.
- Frequent nosebleeds, turning blue even with a minor bruise: This is due to a decrease in platelets, which is called thrombocytopenia.
- Splenomegaly : An enlargement of the spleen, located in the upper left side of your abdomen.
- Hepatomegaly : Enlargement of the liver.
- Unexplained weight loss.
- Night sweats.
- Bone pain.
- Fever.
Remember, not everyone with these symptoms has CMML. But if these symptoms persist, it's best to see a doctor.
Is there a specific cause for CMML?
Researchers still don't know exactly what causes CMML. However, they have identified several gene mutations that are associated with the disease. If you are diagnosed with CMML, you likely have more than one gene mutation. Some of the most common gene mutations include:
- `TET2`
- `SRSF2`
- `ASXL1`
- `RAS` (this is the most common)
Your doctor will tell you more about this gene.
Who is at higher risk of developing CMML?
There are several risk factors that can affect the development of CMML:
- Age: The risk of developing this disease increases as you get older. The average age of diagnosis is between 73 and 75 years old. This means that half of those diagnosed with the disease are younger than that, and the other half are older.
- Gender: CMML is more common in men than in women.
- Previous cancer treatment: About one in ten people who develop CMML have previously received chemotherapy or radiation for cancer. But doctors only give these treatments if the benefits of the treatment clearly outweigh the risk of developing cancer in the future.
What other complications can occur in this condition?
About two in ten people with CMML will develop another serious blood cancer called acute myeloid leukemia (AML). Talk to your doctor about your risk of developing AML based on your diagnosis and risk factors.
How do doctors diagnose CMML?
Your doctor will ask about your symptoms and take your medical history. Then they will do several tests to check your blood cells. These tests may include:
- Complete blood count (CBC): If the number of monocytes is too high (monocytosis), it may be a sign of CMML.
- Peripheral blood smear: If monocytes appear irregular or immature (blast cells) when viewed under a microscope, this can also be a sign of CMML.
- Bone marrow biopsy: Sometimes the doctor may need to take a small sample of bone marrow and test it in the lab to see if there are any abnormal monocytes.
- Genetic testing: Doctors also look for gene mutations associated with other blood cancers. This allows them to rule out other diseases that have similar symptoms and blood test results.
What are the stages of CMML?
Doctors determine how far CMML has spread, or how severe it is (cancer staging), based on the number of blast cells in your blood and bone marrow. These two stages are:
- CMML-1: Fewer than 4 out of 100 cells in your blood are blast cells. Fewer than 9 out of 100 cells in your bone marrow are blast cells.
- CMML-2: Between 5 and 19 out of 100 cells in your blood are blast cells. Between 10 and 19 out of 100 cells in your bone marrow are blast cells.
It is at this stage that your doctor will decide what treatment is most appropriate and effective for you.
What are the treatments for CMML?
First, you may need treatment to make sure you have enough healthy blood cells. This may include medication to increase your blood cell count or regular blood transfusions. This may also be part of palliative care to control symptoms.
Other treatments that directly target CMML are:
- Allogeneic stem cell transplant: This is the only treatment that can completely cure CMML. However, it is not suitable for everyone. It can also cause life-threatening complications such as graft-versus-host disease.
- Chemotherapy: Chemotherapy drugs stop the uncontrolled growth of monocytes. This can help relieve symptoms. This uses drugs such as Hydroxyurea and Hypomethylating agents (HMA).
- Clinical trials: If other treatments don't help, your doctor may suggest that you take part in a clinical trial. Clinical trials are currently investigating the effectiveness of new treatments (e.g., targeted therapy, immunotherapy) for CMML.
When should I see the doctor?
You will need to see your doctor regularly (usually once a month to once every six months). It is very important that you keep these appointments. During these appointments, your doctor will ask about your symptoms, do blood tests, check how well your treatment is working, and make any necessary adjustments.
In the meantime, if you experience any unexpected, severe side effects from your treatment , talk to your doctor immediately . Your doctor will tell you what symptoms to watch out for, depending on the treatment you are receiving.
What can you expect when living with this condition?
The median life expectancy for someone diagnosed with CMML is about one to three years. Again, the "median" is a middle value. This means that half of the population may have a shorter life expectancy and half a longer life expectancy. However, there are many factors that determine your prognosis. These include:
- Blood test results: Your blood cell counts can give clues about your prognosis. Your monocyte, blast cell, and platelet counts are important values. Your hemoglobin level is also an important value that your doctor will often check.
- Genetic mutations: Some genetic mutations, for example a mutation in the `ASXL1` gene, are associated with a worse prognosis.
- Frequency of blood transfusions: Unless you need frequent blood transfusions to restore your blood cells, your outcome is usually good.
Your prognosis also depends on whether your condition progresses to `AML` (acute myeloid leukemia). This is more likely to happen if you have `CMML-2`.
What can I do to stay well and strong?
If you have CMML, one of the best things you can do is take responsibility for your health in every way possible . At this time, it is essential to eat nutritious foods and get enough sleep. A balance between being active and getting enough rest is also important. Connecting with others who are living with cancer is a great way to combat feelings of loneliness. Talk to a therapist who has experience working with cancer patients.
Cancer can make a person feel helpless, but remember, you are still in control of your life . And there are treatments to help you.
Living with CMML is not easy. Your outcome depends on many factors that are unique to you. Ask your doctor to explain what these factors are and how they affect your prognosis. Understand your treatment options so you can be confident that the care you choose will meet your goals.
The most important message to take home
CMML is a serious condition. But if you are aware of it, work with your doctor, get proper treatment, and make good lifestyle changes, you can try to live well with this condition. Never give up hope. Your family, friends, and doctors are there to help you. You are not alone. If you have any questions or concerns, don't be afraid to ask your doctor. It is your right.
` CMML, Chronic Myelomonocytic Leukemia, Blood Cancer, Bone Marrow, Monocytes, Symptoms, Treatment
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