Chronic Myelomonocytic Leukemia with Good Response to Low-dose Etoposide

Abstract

58-year-old man was admitted with cervical tumor and leukocytosis. Physical examination indicated splenomegaly and cervical abscess. Laboratory data showed WBC 55,000/μl, Hb 7.9 g/dl, and PLT 4.5×10⁴/μl. After cure of the abscess, WBC counts were still high with 1,500-2,000/μl monocytes, and anemia and thrombocytopenia persisted. Bone marrow aspiration showed myeloid hyperplasia and trilineage myelodysplasia. The Ph¹ chromosome could not be detected. The case was diagnosed as chronic myelomonocytic leukemia and treated with oral etoposide (25 mg/day). After 2 weeks, the dose was increased to 50 mg, and then modified according to the blood counts. WBC counts are presently being maintained between 7,000 and 12,000/μl, and RBC and PLT counts have gradually become normal. Splenomegaly almost disappeared and dysplastic change in bone marrow improved somewhat. At nine months following the start of chemotherapy with etoposide, remission is maintained by treatment with 25 mg of etoposide on alternate days. This case suggests that low-dose etoposide is useful for treating CMMoL.