58-year-old man was admitted with cervical
tumor and
leukocytosis. Physical examination indicated
splenomegaly and cervical
abscess. Laboratory data showed WBC 55,000/microliters,
Hb 7.9g/dl, and PLT 4.5 x 10(4)/microliters. After cure of the
abscess, WBC counts were still high with 1,500-2,000/microliters 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 (25mg/day). After 2 weeks, the dose was increased to 50mg, and then modified according to the blood counts. WBC counts are presently being maintained between 7,000 and 12,000/microliters, 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 25mg of
etoposide on alternate days. This case suggests that low-dose
etoposide is useful for treating CMMoL.