Myelodysplastic/ Myeloproliferative Neoplasms Treatment (PDQ®): Treatment - Patient Information [NCI]

General Information About Myelodysplastic / Myeloproliferative Neoplasms

Myelodysplastic/myeloproliferative neoplasms are a group of diseases in which the bone marrow makes too many white blood cells.

Myelodysplastic/myeloproliferative neoplasms are diseases of the blood and bone marrow.

Anatomy of the bone. The bone is made up of compact bone, spongy bone, and bone marrow. Compact bone makes up the outer layer of the bone. Spongy bone is found mostly at the ends of bones and contains red marrow. Bone marrow is found in the center of most bones and has many blood vessels. There are two types of bone marrow: red and yellow. Red marrow contains blood stem cells that can become red blood cells, white blood cells, or platelets. Yellow marrow is made mostly of fat.

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. A lymphoid stem cell becomes a white blood cell. A myeloid stem cell becomes one of three types of mature blood cells:

• red blood cells that carry oxygen and other substances to all tissues of the body
• granulocytes and other types of white blood cells that help the body's immune system respond to infection, allergens, and inflammation
• platelets that help stop bleeding by forming clots

Blood cell development. A blood stem cell goes through several steps to become a red blood cell, platelet, or white blood cell.

Myelodysplastic/myeloproliferative neoplasms have features of both myelodysplastic syndromes and myeloproliferative neoplasms.

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 become one or more types of blood cells and the total number of blood cells slowly increases.

This summary is about neoplasms that have features of both myelodysplastic and myeloproliferative diseases. For more information about related diseases, see:

• Myelodysplastic Syndromes Treatment
• Myeloproliferative Neoplasms Treatment
• Chronic Myeloid Leukemia Treatment

There are two main types of myelodysplastic/myeloproliferative neoplasms.

The two main types of myelodysplastic/myeloproliferative neoplasms in adults include:

• chronic myelomonocytic leukemia (CMML)
• atypical chronic myeloid leukemia (CML)

When a myelodysplastic/myeloproliferative neoplasm does not match any of these types, it is called myelodysplastic/myeloproliferative neoplasm, unclassifiable (MDS/MPN-UC).

Myelodysplastic/myeloproliferative neoplasms may progress to acute leukemia.

Tests that examine the blood and bone marrow are used to diagnose myelodysplastic/myeloproliferative neoplasms.

In addition to asking about your personal and family health history and doing a physical exam, your doctor may perform the following tests and procedures:

• Complete blood count (CBC) with differential: A procedure in which a sample of blood is drawn and checked for:
  • 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
  
  
  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.
• Peripheral blood smear: A procedure in which a sample of blood is checked for blast cells, the number and kinds of white blood cells, the number of platelets, and changes in the shape of blood cells.
• 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.
• 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.
  
  Bone marrow aspiration and biopsy. After a small area of skin is numbed, a long, hollow needle is inserted through the patient's skin and hip bone into the bone marrow. A sample of bone marrow and a small piece of bone are removed for examination under a microscope.

  The following tests may be done on the sample of tissue that is removed:

  • Cytogenetic analysis: A laboratory test in which the chromosomes of cells in a sample of bone marrow or blood are counted and checked for any changes, such as broken, missing, rearranged, or extra chromosomes. Changes in certain chromosomes may be a sign of cancer. Cytogenetic analysis is used to help diagnose cancer, plan treatment, or find out how well treatment is working. The cancer cells in myelodysplastic/myeloproliferative neoplasms do not contain the Philadelphia chromosome that is present in chronic myeloid leukemia.
  • Immunocytochemistry: A laboratory test that uses antibodies to check for certain antigens (markers) in a sample of a patient's bone marrow. The antibodies are usually linked to an enzyme or a fluorescent dye. After the antibodies bind to the antigen in the sample of the patient's bone marrow, the enzyme or dye is activated, and the antigen can then be seen under a microscope. This type of test is used to help diagnose cancer and to tell the difference between myelodysplastic/myeloproliferative neoplasms, leukemia, and other conditions.

Chronic Myelomonocytic Leukemia

Chronic myelomonocytic leukemia is a disease in which too many myelocytes and monocytes (immature white blood cells) are made in the bone marrow.

In chronic myelomonocytic leukemia (CMML), the body tells too many blood stem cells to become 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 chronic myelomonocytic leukemia.

Anything that increases a person's chance of getting a disease is called a risk factor. Not every person with one or more of these risk factors will develop CMML, and it will develop in some people who don't have any known risk factors. Talk with your doctor if you think you may be at risk. Risk factors for CMML include:

• 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

Signs and symptoms of chronic myelomonocytic leukemia include fever, weight loss, and feeling very tired.

These and other signs and symptoms may be caused by CMML or by other conditions. Check with your doctor if you have:

• fever for no known reason
• infection
• tiredness
• 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 and treatment options for CMML depend on:

• 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

Atypical Chronic Myeloid Leukemia

Atypical chronic myeloid leukemia is a disease in which too many granulocytes (immature white blood cells) are made in the bone marrow.

In atypical chronic myeloid leukemia (CML), the body tells too many blood stem cells to become 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 atypical CML and CML look alike under a microscope. However, in atypical CML a certain chromosome change, called the "Philadelphia chromosome," is not there.

Signs and symptoms of atypical chronic myeloid leukemia include easy bruising or bleeding and feeling tired and weak.

These and other signs and symptoms may be caused by atypical CML or by other conditions. Check with your doctor if you have:

• shortness of breath
• pale skin
• tiredness and weakness
• 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 for atypical CML depends on the number of red blood cells and platelets in the blood.

Myelodysplastic / Myeloproliferative Neoplasm, Unclassifiable

Myelodysplastic/myeloproliferative neoplasm, unclassifiable, is a disease that has features of both myelodysplastic and myeloproliferative diseases but is not chronic myelomonocytic leukemia or atypical chronic myeloid leukemia.

In myelodysplastic/myeloproliferative neoplasm, unclassifiable (MDS/MPD-UC), the body tells too many blood stem cells to become 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/MPN-UC is a very rare disease. Because it is so rare, the factors that affect risk and prognosis are not known.

Signs and symptoms of myelodysplastic/myeloproliferative neoplasm, unclassifiable, include fever, weight loss, and feeling very tired.

These and other signs and symptoms may be caused by MDS/MPN-UC or by other conditions. Check with your doctor if you have:

• fever or frequent infections
• shortness of breath
• tiredness and weakness
• 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

Stages of Myelodysplastic / Myeloproliferative Neoplasms

There is no standard staging system for myelodysplastic/myeloproliferative neoplasms.

The process used to find out if cancer has spread is called staging. There is no standard staging system for myelodysplastic/myeloproliferative neoplasms. It is important to know the type of myelodysplastic/myeloproliferative neoplasm in order to plan treatment.

Treatment Option Overview

There are different types of treatment for patients with myelodysplastic/myeloproliferative neoplasms.

Different types of treatments are available for patients with myelodysplastic/myeloproliferative neoplasms. 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.

The following types of treatment are used:

Watchful waiting

Watchful waiting is closely monitoring a patient's condition without giving any treatment until signs or symptoms appear or change. It is sometimes used to treat chronic myelomonocytic leukemia in patients with no or mild symptoms.

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). Combination chemotherapy is treatment using more than one anticancer drug.

For more information, see Drugs Approved for Myeloproliferative Neoplasms or Myelodysplastic Syndromes.

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

Chemotherapy is given to kill abnormal cells or cancer cells. Healthy cells, including blood -forming cells, are also destroyed by the cancer treatment. Stem cell transplant is a treatment to replace the blood-forming cells. 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 patient completes chemotherapy, 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.
Donor stem cell transplant. (Step 1): Four to five days before donor stem cell collection, the donor receives a medicine to increase the number of stem cells circulating through their bloodstream (not shown). The blood-forming stem cells are then collected from the donor through a large vein in their arm. The blood flows through an apheresis machine that removes the stem cells. The rest of the blood is returned to the donor through a vein in their other arm. (Step 2): The patient receives chemotherapy to kill cancer cells and prepare their body for the donor stem cells. The patient may also receive radiation therapy (not shown). (Step 3): The patient receives an infusion of the donor stem 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.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells.

• Tyrosine kinase inhibitor (TKI) therapy: TKI therapy blocks signals that tumors need to grow. TKIs block the enzyme tyrosine kinase that causes stem cells to become more blood cells (blasts) than the body needs. Imatinib mesylate (Gleevec) is used to treat myelodysplastic/myeloproliferative neoplasm, unclassifiable.

For more information, see Drugs Approved for Myeloproliferative Neoplasms or Myelodysplastic Syndromes.

New types of treatment are being tested in clinical trials.

For some people, joining a clinical trial may be an option. There are different types of clinical trials for people with cancer. For example, a treatment trial tests new treatments or new ways of using current treatments. Supportive care and palliative care trials look at ways to improve quality of life, especially for those who have side effects from cancer and its treatment.

You can use the clinical trial search to find NCI-supported cancer clinical trials accepting participants. The search allows you to filter trials based on the type of cancer, your age, and where the trials are being done. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Learn more about clinical trials, including how to find and join one, at Clinical Trials Information for Patients and Caregivers.

Treatment for myelodysplastic/myeloproliferative neoplasms may cause side effects.

For information about side effects caused by treatment for cancer, visit our Side Effects page.

Follow-up care may be needed.

As you go through treatment, you will have follow-up tests or check-ups. Some tests that were done to diagnose or stage the cancer may be repeated 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.

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).

Treatment of Chronic Myelomonocytic Leukemia

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of chronic myelomonocytic leukemia (CMML) may include:

• watchful waiting
• chemotherapy with one or more agents
• stem cell transplant

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Treatment of Atypical Chronic Myeloid Leukemia

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of atypical chronic myeloid leukemia (CML) may include chemotherapy.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Treatment of Myelodysplastic / Myeloproliferative Neoplasm, Unclassifiable

For information about the treatments listed below, see the Treatment Option Overview section.

Because myelodysplastic /myeloproliferative neoplasm, unclassifiable (MDS/MPN-UC) is a rare disease, little is known about its treatment. Treatment may include:

• supportive care treatments to manage problems caused by the disease such as infection, bleeding, and anemia
• targeted therapy (imatinib mesylate)

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

To Learn More About Myelodysplastic / Myeloproliferative Neoplasms

For more information from the National Cancer Institute about myelodysplastic/myeloproliferative neoplasms, visit:

• Myeloproliferative Neoplasms Home Page
• Stem Cell Transplants in Cancer Treatment
• Drugs Approved for Myeloproliferative Neoplasms or Myelodysplastic Syndromes
• Targeted Therapy to Treat Cancer

For general cancer information and other resources from the National Cancer Institute, visit:

• About Cancer
• Cancer Staging
• Chemotherapy and You: Support for People With Cancer
• Radiation Therapy and You: Support for People With Cancer
• Coping with Cancer
• Questions to Ask Your Doctor about Cancer
• For Survivors, Caregivers, and Advocates

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. 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 come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

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Purpose of This Summary

This PDQ cancer information summary has current information about the treatment of myelodysplastic/ myeloproliferative neoplasms. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.

Clinical Trial Information

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.

Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).

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PDQ® Adult Treatment Editorial Board. PDQ Myelodysplastic/ Myeloproliferative Neoplasms Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/myeloproliferative/patient/mds-mpd-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389360]

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Last Revised: 2025-03-06

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