A Study of Eltrombopag in Patients With CMML and Thrombocytopenia

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