Edema of the lower extremities becomes more common with disease progression and may be produced by the enlarged spleen and liver with compression of the inferior vena cava. Infection, especially pneumonia, may supervene and may be related to subtle immune deficiency even in the absence of neutropenia, although both may be present. Coexisting serious illnesses, such as congestive heart failure or chronic lung disease, usually are present when death is The causes of death in patients with AMM are variable. Infection, hemorrhage, cardiac failure, and cerebrovascular accidents are common, and death attributable to renal failure, hepatic failure, or thrombosis is reported in most series. In one series of 53 cases, death was due to cardiac causes in 18 cases, to hemorrhage in 13 cases, to leukemic conversion in 12 cases, and to infection in 7 cases.
Standard care is supportive and directed toward specific complications.
Because of variability in disease progression, many patients require no therapy for prolonged periods. Generally, asymptomatic patients require only observation. Allopurinol should be used to keep serum levels of uric acid within normal limits to avoid urate nephropathy and renal calculi and to reduce the Androgens and Corticosteroids Androgens may be given to treat severe anemia, especially when the anemia results primarily from decreased red cell production . Because chemotherapy rarely induces a hematologic remission and has not yet been shown to alter the overall course of disease, most investigators have restricted its use to relief of symptoms. Cytoreductive therapy can often reduce the size of the liver and spleen and alleviate weight loss, fever and night sweats.