Question:  What are the treatments for Chronic Myeloproliferative Neoplasms ?
Answer: Key Points
                    - There are different types of treatment for patients with chronic myeloproliferative neoplasms.    - Eleven types of standard treatment are used:          - Watchful waiting     -  Phlebotomy      -  Platelet apheresis      - Transfusion therapy     -  Chemotherapy      -  Radiation therapy      - Other drug therapy     -  Surgery      - Biologic therapy      - Targeted therapy     - High-dose chemotherapy with stem cell transplant        - New types of treatment are being tested in clinical trials.    - Patients may want to think about taking part in a clinical trial.    - Patients can enter clinical trials before, during, or after starting their cancer treatment.    - Follow-up tests may be needed.
                
                
                    There are different types of treatment for patients with chronic myeloproliferative neoplasms.
                    Different types of treatments are available for patients with chronic 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. 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.
                
                
                    Eleven types of standard treatment are used:
                    Watchful waiting     Watchful waiting is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change.        Phlebotomy      Phlebotomy is a procedure in which blood is taken from a vein. A sample of blood may be taken for tests such as a CBC or blood chemistry. Sometimes phlebotomy is used as a treatment and blood is taken from the body to remove extra red blood cells. Phlebotomy is used in this way to treat some chronic myeloproliferative neoplasms.         Platelet apheresis      Platelet apheresis is a treatment that uses a special machine to remove platelets from the blood. Blood is taken from the patient and put through a blood cell separator where the platelets are removed. The rest of the blood is then returned to the patients bloodstream.       Transfusion therapy     Transfusion therapy (blood transfusion) is a method of giving red blood cells, white blood cells, or platelets to replace blood cells destroyed by disease or cancer treatment.        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). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.    See Drugs Approved for Myeloproliferative Neoplasms for more information.        Radiation therapy      Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:            -  External radiation therapy uses a machine outside the body to send radiation toward the cancer.     -  Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.           The way the radiation therapy is given depends on the type of cancer being treated. External radiation therapy is used to treat chronic myeloproliferative neoplasms, and is usually directed at the spleen.       Other drug therapy     Prednisone and danazol are drugs that may be used to treat anemia in patients with primary myelofibrosis.     Anagrelide therapy is used to reduce the risk of blood clots in patients who have too many platelets in their blood. Low-dose aspirin may also be used to reduce the risk of blood clots.     Thalidomide, lenalidomide, and pomalidomide are drugs that prevent blood vessels from growing into areas of tumor cells.     See Drugs Approved for Myeloproliferative Neoplasms for more information.        Surgery      Splenectomy (surgery to remove the spleen) may be done if the spleen is enlarged.        Biologic therapy      Biologic therapy is a treatment that uses the patient's immune system to fight cancer or other diseases. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against disease. This type of treatment is also called biotherapy or immunotherapy. Interferon alfa and pegylated interferon alpha are biologic agents commonly used to treat some chronic myeloproliferative neoplasms.      Erythropoietic growth factors are also biologic agents. They are used to stimulate the bone marrow to make red blood cells.        Targeted therapy     Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Tyrosine kinase inhibitors are targeted therapy drugs that block signals needed for tumors to grow.      Ruxolitinib is a tyrosine kinase inhibitor used to treat certain types of myelofibrosis.    See Drugs Approved for Myeloproliferative Neoplasms for more information.    Other types of targeted therapies are being studied in clinical trials.       High-dose chemotherapy with stem cell transplant     High-dose chemotherapy with stem cell transplant is a method of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. 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 chemotherapy is completed, 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.
                
                
                    New types of treatment are being tested in clinical trials.
                    Information about clinical trials is available from the NCI website.
                
                
                    Patients may want to think about taking part in a clinical trial.
                    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.   Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.   Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
                
                
                    Patients can enter clinical trials before, during, or after starting their cancer treatment.
                    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.   Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
                
                
                    Follow-up tests may be needed.
                    Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order 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). These tests are sometimes called follow-up tests or check-ups.
                
                
								            Treatment Options for Chronic Myeloproliferative Neoplasms
								            
								                
								                    Chronic Myelogenous Leukemia
								                    See the PDQ summary about Chronic Myelogenous Leukemia Treatment for information.
								                
								                
								                    Polycythemia Vera
								                    The purpose of treatment for polycythemia vera is to reduce the number of extra blood cells. Treatment of polycythemia vera may include the following:             -  Phlebotomy.     -  Chemotherapy with or without phlebotomy.     -  Biologic therapy using interferon alfa or pegylated interferon alpha.     - Low-dose aspirin.            Check the list of NCI-supported cancer clinical trials that are now accepting patients with polycythemia vera. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
								                
								                
								                    Primary Myelofibrosis
								                    Treatment of primary myelofibrosis in patients without signs or symptoms is usually watchful waiting.    Patients with primary myelofibrosis may have signs or symptoms of anemia. Anemia is usually treated with transfusion of red blood cells to relieve symptoms and improve quality of life. In addition, anemia may be treated with:             -  Erythropoietic growth factors.     -  Prednisone.     -  Danazol.     -  Thalidomide, lenalidomide, or pomalidomide, with or without prednisone.            Treatment of primary myelofibrosis in patients with other signs or symptoms may include the following:            -  Targeted therapy with ruxolitinib.     -  Chemotherapy.     -  Donor stem cell transplant.     - Thalidomide, lenalidomide, or pomalidomide.     -  Splenectomy.     -  Radiation therapy to the spleen, lymph nodes, or other areas outside the bone marrow where blood cells are forming.     -  Biologic therapy using interferon alfa or erythropoietic growth factors.     - A clinical trial of other targeted therapy drugs.            Check the list of NCI-supported cancer clinical trials that are now accepting patients with primary myelofibrosis. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
								                
								                
								                    Essential Thrombocythemia
								                    Treatment of essential thrombocythemia in patients younger than 60 years who have no signs or symptoms and an acceptable platelet count is usually watchful waiting. Treatment of other patients may include the following:            -  Chemotherapy.     -  Anagrelide therapy.     -  Biologic therapy using interferon alfa or pegylated interferon alpha.     - Platelet apheresis.     - A clinical trial of a new treatment.            Check the list of NCI-supported cancer clinical trials that are now accepting patients with essential thrombocythemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
								                
								                
								                    Chronic Neutrophilic Leukemia
								                    Treatment of chronic neutrophilic leukemia may include the following:            -  Donor bone marrow transplant.     -  Chemotherapy.     -  Biologic therapy using interferon alfa.      - A clinical trial of a new treatment.            Check the list of NCI-supported cancer clinical trials that are now accepting patients with chronic neutrophilic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
								                
								                
								                    Chronic Eosinophilic Leukemia
								                    Treatment of chronic eosinophilic leukemia may include the following:            -  Bone marrow transplant.     -  Biologic therapy using interferon alfa.     - A clinical trial of a new treatment.            Check the list of NCI-supported cancer clinical trials that are now accepting patients with chronic eosinophilic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.