Chronic myeloid leukemia (CML) is a type of cancer that affects the bone marrow. It starts in the cells that form blood, with cancer cells building up slowly over time. The diseased cells don’t die when they should and gradually crowd out healthy cells.
CML is likely caused by a genetic mutation that causes a blood cell to produce too much of the tyrosine kinase protein. This protein is what allows the cancer cells to grow and multiply.
There are several different treatment options for CML. These treatments focus on getting rid of blood cells containing the genetic mutation. When these cells are effectively eliminated, the disease can go into remission.
The first step in treatment is often a class of medications called tyrosine kinase inhibitors (TKIs). These are very effective at managing CML when it’s in the chronic phase, which is when the number of cancer cells in the blood or bone marrow is relatively low.
TKIs work by blocking the action of tyrosine kinase and stopping the growth of new cancer cells. These drugs can be taken by mouth at home.
TKIs have become the standard treatment for CML, and there are several available. However, not everyone responds to treatment with TKIs. Some people may even become resistant. In these cases, a different drug or treatment may be recommended.
People who respond to treatment with TKIs often need to take them indefinitely. While TKI treatment can lead to remission, it doesn’t completely eliminate CML.
Gleevec was the first TKI to hit the market. Many people with CML respond quickly to Gleevec. Side effects are usually mild and may include:
- nausea and vomiting
- fluid buildup, particularly in the face, abdomen, and legs
- joint and muscle pain
- skin rash
- low blood count
Dasatinib can be used as a first-line treatment, or when Gleevec doesn’t work or can’t be tolerated. Sprycel has similar side effects as Gleevec.
Sprycel also appears to increase the risk of pulmonary arterial hypertension (PAH). PAH is a dangerous condition that occurs when blood pressure is too high in the arteries of the lungs.
Another potentially serious side effect of Sprycel is an increased risk of pleural effusion. This is when fluid builds up around the lungs. Sprycel isn’t recommended for those who have heart or lung problems.
Like Gleevec and Sprycel, Nilotinib (Tasigna) can also be a first-line treatment. Additionally, it can be used if other drugs aren’t effective or side effects are too great.
Tasigna has the same side effects as other TKIs, along with some potentially more serious side effects that doctors should monitor. These may include:
- inflamed pancreas
- liver problems
- electrolyte problems
- hemorrhage (bleeding)
- a serious and potentially fatal heart condition called prolonged QT syndrome
While Bosutinib (Bosulif) can sometimes be used as a first-line treatment for CML, it’s typically used in people who’ve already tried other TKIs.
In addition to the side effects that are common to other TKIs, Bosulif may also cause liver damage, kidney damage, or heart problems. However, these types of side effects are rare.
Ponatinib (Iclusig) is the only drug that targets a specific gene mutation. Because of the potential for severe side effects, it’s only appropriate for those who have this gene mutation or who have tried all other TKIs without success.
Iclusig increases the risk of blood clots that can cause a heart attack or stroke and may also cause congestive heart failure. Other potential side effects include liver problems and an inflamed pancreas.
In the accelerated phase of CML, cancer cells begin to build up very quickly. Because of this, people in this phase may be less likely to have a sustained response to some types of treatment.
Like in the chronic phase, one of the first treatment options for accelerated phase CML is the use of TKIs. If a person is already taking Gleevec, their dose may be increased. It’s also possible that they’ll be switched to a newer TKI instead.
Other potential treatment options for accelerated phase include a stem cell transplant or chemotherapy. These may be particularly recommended in those for whom treatment with TKIs hasn’t worked.
Overall, the number of people undergoing stem cell transplants for CML
In a stem cell transplant, high doses of chemotherapy drugs are used to kill the cells in your bone marrow, including the cancer cells. Afterward, blood-forming stem cells from a donor, often a sibling or family member, are introduced into your bloodstream.
These new donor cells can go on to replace the cancer cells that have been eliminated by the chemotherapy. Overall, a stem cell transplant is the only type of treatment that can potentially cure CML.
Stem cell transplants can be very strenuous to the body and carry a risk of serious side effects. Because of this, they may only be recommended for people with CML who are younger and are in generally good health.
Chemotherapy was the standard treatment for CML before TKIs. It’s still helpful for some patients who haven’t had good results with TKIs.
Sometimes, chemotherapy will be prescribed along with a TKI. Chemotherapy can be used to kill existing cancerous cells, while TKIs keep new cancer cells from forming.
The side effects associated with chemotherapy depend on the chemotherapy drug that’s being taken. They can include things like:
- nausea and vomiting
- hair loss
- skin rash
- increased susceptibility to infections
Clinical trials focused on CML treatments are ongoing. The aim of these trials is typically to test the safety and effectiveness of new CML treatments or to improve upon an existing CML treatment.
Participating in a clinical trial can give you access to the newest, most innovative types of treatment. However, it’s also important to remember that the treatment used in a clinical trial may turn out to not be as effective as the standard CML treatments.
If you’re interested in enrolling in a clinical trial, talk with your doctor. They can give you an idea of which trials you may be eligible for as well as the different benefits and risks that are associated with each of them.
If you’d like to get an idea of the trials going on right now, there are some resources available to you. The National Cancer Institute maintains
After a cancer diagnosis, you’ll want to find a hospital that has specialists focused on CML treatment. There are a few ways that you can go about this:
- Ask for a referral. Your primary care doctor may be able to give you information on the best hospitals in your area for treating CML.
- Use the Commission on Cancer Hospital Locator. Managed by the American College of Surgeons, this tool allows you to compare different cancer treatment facilities in your area.
- Check out the National Cancer Institute-designated centers. These can include centers that provide basic cancer treatments to more specialized, comprehensive care. You can find a list of them
Some of the side effects that are common to many CML treatments include things like:
- aches and pains
- nausea and vomiting
- low blood count
Fatigue may ebb and flow. Some days you may have a lot of energy, and other days you may feel very tired. Exercise can often be used to combat fatigue. Talk to your doctor about which types of physical activity may be appropriate for you.
Your doctor will also work with you to develop a plan to help manage pain. This can include things like taking prescribed medications, meeting with a pain specialist, or using complementary therapies like massage or acupuncture.
Medications can help to ease symptoms like nausea and vomiting. Additionally, you may choose to avoid foods or drinks that make these symptoms worse.
Low blood counts can make you more prone to several conditions like anemia, easy bleeding, or coming down with infections. Monitoring for these conditions is very important so that you can recognize their symptoms and seek timely care.
Tips for staying healthy during CML treatment
Follow the additional tips below to help stay as healthy as possible while undergoing CML treatment:
- Continue to stay physically active.
- Eat a healthy diet, focusing on fresh fruits and vegetables.
- Limit the amount of alcohol that you consume.
- Wash your hands frequently and sanitize high-touch surfaces to avoid getting an infection.
- Try to quit smoking.
- Take all medications as directed.
- Let your care team know if you experience new or worsening symptoms.
It’s completely normal to feel a variety of things while you’re undergoing treatment for CML. In addition to coping with the physical effects of treatment, you may also sometimes feel overwhelmed, anxious, or sad.
Be open and honest with your loved ones about how you’re feeling. Remember that they may be looking for ways to support you, so let them know how they can help. This can include things like running errands, helping around the house, or even just lending an attentive ear.
Sometimes, speaking with a mental health professional about your feelings may also be helpful. If this is something that you’re interested in, your doctor can help refer you to a counselor or therapist.
Additionally, sharing your experiences with others who are going through something similar can also be very beneficial. Be sure to ask about cancer support groups in your area.
Complementary and alternative medicine (CAM) includes non-standard health practices, such as homeopathy, that are used in place of or along with conventional medical treatments.
There are currently no CAM therapies that are proven to directly treat CML.
However, you may find that some types of CAM help you cope with CML symptoms or medication side effects like fatigue or pain. Some examples may include things like:
Always talk to your doctor before beginning any type of CAM therapy. It’s possible that some types of CAM therapies may make your CML treatment less effective.
The first-line treatment for CML is TKIs. Although these drugs have several possible side effects, some of which can be serious, they’re often very effective for treating CML.
In fact, 5- and 10-year survival rates for CML have
Not every case of CML responds to treatment with TKIs. Some people may develop resistance to them, while others may have more aggressive or high-risk disease types. In these situations, chemotherapy or a stem cell transplant may be recommended.
It’s always important to talk with your doctor before starting a new CML treatment. They can give you an idea of the types of side effects that you may experience as well as ways to help you cope with them.