Chronic myeloid leukemia (CML) is a type of blood cancer. It’s sometimes known as chronic myelogenous leukemia, chronic granulocytic leukemia, or chronic myelocytic leukemia.
There are three phases of CML: chronic phase, accelerated phase, and blast crisis phase. Most cases of CML are diagnosed relatively early, in the chronic phase.
The recommended first-line treatment for the chronic phase of CML is tyrosine kinase inhibitor (TKI) therapy. This treatment can potentially bring the cancer into remission, which happens when no more than 1 in 32,000 cells in your blood are cancerous.
TKI therapy is well-tolerated by most people, but it can cause some side effects or affect your life in other ways. It can also pose risks during pregnancy.
If you’re thinking about taking a break from TKI therapy, here are six things to consider.
If you decide to stop treatment before the cancer is in remission, CML can get worse.
Without effective treatment, CML eventually progresses from the chronic phase to the accelerated and blast crisis phases. In the advanced phases, CML causes more severe symptoms and reduced life expectancy.
Getting treatment during the chronic phase can help stop CML from progressing. It can also improve your chances of obtaining remission. If you’re in remission, you may continue to live a full life for years to come.
Several treatments are available for the chronic phase. If the first treatment you try doesn’t work or causes intolerable side effects, your doctor may prescribe other treatments.
CML can potentially come back after going into remission. This is known as relapse.
If you obtain remission after treatment with TKIs, your doctor will likely advise you to continue TKI therapy for at least two years to lower your risk of relapse.
Your doctor will also ask you to attend regular follow-up appointments and undergo blood and bone marrow tests to check for signs of relapse.
If the cancer comes back, your doctor can help you understand your treatment options. Several treatments are available for relapsed CML.
To keep the cancer in remission, many survivors of CML receive lifelong TKI therapy.
But some people can stop TKI therapy and stay in remission for several months or longer.
According to the Leukemia & Lymphoma Society, you might be a good candidate for attempting treatment-free remission if:
- the cancer has never progressed past the chronic phase
- you’ve been taking a TKI for at least three years
- you’ve been in stable remission for at least two years
- you have access to a qualified healthcare professional who can monitor you for signs of relapse
To learn if you might be a good candidate for attempting treatment-free remission, talk to your doctor. They can help you understand the potential benefits and risks.
If you’re a good candidate for attempting treatment-free remission, there may be benefits to stopping TKI therapy. For example:
- It reduces the risk of side effects and interactions. Although most people tolerate TKI therapy, it can cause some side effects and interact with certain drugs, supplements, and foods.
- It may lower the costs of your care. Depending on your health insurance coverage and eligibility for financial support programs, TKI therapy may be expensive.
- It may support your family planning goals. Although more research is needed, some evidence suggests that TKI therapy increases the risk of miscarriage and birth defects in pregnant people who receive this treatment.
Your doctor can help you weigh the potential benefits and risks of stopping TKI therapy.
If you stop taking TKIs, you might develop withdrawal symptoms, such as skin rash or pain in your bones and muscles.
In most cases, these symptoms can be managed with over-the-counter pain relievers. In some cases, your doctor might prescribe corticosteroids to provide relief.
According to guidelines from the National Comprehensive Cancer Network, approximately 40 to 60 percent of people who attempt treatment-free remission experience relapse within 6 months. When those people restart treatment right away, almost all of them obtain remission again.
If you stop treatment with TKIs, it’s important to continue visiting your doctor on a regular basis. They can use blood and bone marrow tests to monitor you for signs of relapse.
If the cancer comes back, your doctor will likely advise you to restart treatment with TKIs. In some cases, they might recommend other treatments, too.
If you’re thinking about taking a break from TKI therapy, talk to your doctor. They can help you understand the potential upsides and downsides of pausing or stopping treatment.
In some cases, you might be a good candidate to try treatment-free remission. But stopping TKI therapy can increase your risk of relapse. Depending on your overall health and other factors, your doctor might encourage you to continue TKI therapy or try other treatments.