A Study of Eltrombopag in Patients With CMML and Thrombocytopenia

All eligible patients will be treated with eltrombopag for a minimum of twelve weeks and a maximum of 24 months.

Inclusion criteria

• Age 18 years or older
• Chronic myelomonocytic leukemia (CMML) according to WHO criteria:
• Stable excess in blood monocytes > 1 G/L
• Lack of bcr-abl rearrangement (or Philadelphia chromosome)
• Bone marrow blast cells < 20%
• Dysplasia of at least one lineage or clonality marker or blood monocytosis during more than 3 months w/o other explanation
• Platelet counts < 50 G/L on two successive blood counts in the 2 weeks preceding inclusion
• Either of D1 or D2 criteria:
• Lack of features of advanced disease If white blood cell count (WBC) < 13 G/L: International Prognostic Scoring System (IPSS) low or intermediate-1

If WBC ≥ 13 G/L: no more than one of the following criteria:

• Clonal cytogenetic abnormality other than t(5;12) (q33; p13)
• Absolute neutrophil count (ANC) > 16 G/L
• Anemia (Hb < 100 g/L)
• Extramedullary localization (documented cutaneous, pleural or pericardial effusion, etc…) OR D2- Features of advanced disease If WBC < 13 G/L: IPSS intermediate-2 or high

If WBC ≥ 13 G/L: two or more of the following criteria:

• Clonal cytogenetic abnormality other than t(5;12) (q33; p13)
• ANC > 16 G/L
• Anemia (Hb < 100 g/L)
• Extramedullary localization (documented cutaneous, pleural or pericardial effusion, etc…) And having resisted (progression or stable disease without hematological improvement according to International Working Group (IWG) 2006 criteria) or relapsed after a treatment with a hypomethylating agent (azacitidine or decitabine for a minimum of 6 cycles)
• Blast cells ≤ 5% in the bone marrow
• Performance status 0-2 on the Eastern Cooperative Oncology Group (ECOG) Scale
• Serum Creatinin < 2 times the upper limit of normal (ULN)
• Alanine transaminase (ALT) and aspartate transaminase (AST) < 3 ULN, total bilirubin < 1.5 ULN (except Gilbert Syndrome)
• Adequate contraception if relevant
• Signed informed consent

Exclusion criteria

• CMML with t(5 ;12) or Platelet-derived growth factor beta receptor (PDGFbetaR) rearrangement
• Acute blastic transformation of CMML with bone marrow blast cells > 20%
• Bone marrow blast cells > 5%
• Patients eligible for allogeneic bone marrow transplantation with an identified donor
• Intensive chemotherapy given less than 3 months before inclusion
• Pregnant or breastfeeding
• Hepatitis C infection
• Splenomegaly > 16 cm by ultrasound or CT scan (Not Applicable in patients without palpable splenomegaly)
• Significant (grade II-IV) myelofibrosis (bone marrow trephine if bone marrow aspirate with poor cellularity, or features of myelofibrosis on the peripheral blood smear (teardrop erythrocytes)
• Clinically relevant thromboembolic risk factor which, in the investigator's opinion, is such that the benefit/risk ratio becomes unfavourable if platelet counts increase
• Liver cirrhosis (Child-Pugh score ≥ 5)
• Prior Cancer (except in situ cervix carcinoma, limited basal cell carcinoma, or other tumors if not active during the last 3 years)
• Serious concomitant systemic disorder, including active bacterial, fungal or viral infection that, in the opinion of the investigator, would compromise the safety of the patient and/or his/her ability to complete the study.
• Hypersensitivity to Eltrombopag