Chronic myeloid leukemia (CML) is also known as chronic myelogenous leukemia. In this type of cancer, the bone marrow produces too many white blood cells.
If the disease isn’t effectively treated, it gets gradually worse. It may progress from the chronic phase, to the accelerated phase, to the blast phase.
If you have CML, your treatment plan will depend in part on the phase of the disease.
Read on to learn more about the treatment options for each phase.
CML tends to be most treatable when it’s diagnosed early, in the chronic phase.
To treat chronic phase CML, your doctor will likely prescribe a type of medication known as a tyrosine kinase inhibitor (TKI).
Several types of TKI are available to treat CML, including:
- imatinib (Gleevec)
- nilotinib (Tasigna)
- dasatinib (Spryrcel)
- bosutinib (Bosulif)
- ponatinib (Iclusig)
Gleevec is often the first type of TKI prescribed for CML. However, Tasigna or Spryrcel may also be prescribed as the first-line treatment.
If those types of TKI don’t work well for you, stop working, or cause intolerable side effects, your doctor may prescribe Bosulif.
Your doctor will only prescribe Iclusig if the cancer doesn’t respond well to other types of TKIs or it develops a type of gene mutation, known as the T315I mutation.
If your body doesn’t respond well to TKIs, your doctor may prescribe chemotherapy drugs or a type of medication known as interferon to treat chronic phase CML.
In rare cases, they may recommend a stem cell transplant. However, this treatment is more commonly used to treat accelerated phase CML.
In accelerated phase CML, leukemia cells begin to multiply more quickly. The cells often develop gene mutations that increase their growth and reduce the effectiveness of treatment.
If you have accelerated phase CML, your recommended treatment plan will depend on the treatments you’ve received in the past.
If you’ve never received any treatment for CML, your doctor will likely prescribe a TKI to start.
If you’ve already been taking a TKI, your doctor may increase your dose or switch you to another type of TKI. If your cancer cells have the T315I mutation, they may prescribe Iclusig.
If TKIs don’t work well for you, your doctor may prescribe treatment with interferon.
In some cases, your doctor may add chemotherapy to your treatment plan. Chemotherapy drugs may help bring the cancer into remission, but they often stop working over time.
If you’re young and relatively healthy, your doctor may recommend a stem cell transplant after you go through other treatments. This will help replenish your blood-forming cells.
In an autologous stem cell transplant, your doctor will collect some of your own stem cells before you get treatment. After treatment, they will infuse those cells back into your body.
In an allogenic stem cell transplant, your doctor will give you stem cells from a well-matched donor. They may follow that transplant with an infusion of white blood cells from the donor.
Your doctor will probably try to bring the cancer into remission with medications before they recommend a stem cell transplant.
In blast phase CML, the cancer cells rapidly multiply and cause more noticeable symptoms.
Treatments tend to be less effective during the blast phase, compared with earlier phases of the disease. As a result, most people with blast phase CML can’t be cured of the cancer.
If you develop blast phase CML, your doctor will consider your prior treatment history.
If you haven’t received any past treatment for CML, they may prescribe high doses of a TKI.
If you’ve already been taking a TKI, they may increase your dose or advise you to switch to another type of TKI. If your leukemia cells have the T315I mutation, they may prescribe Iclusig.
Your doctor might also prescribe chemotherapy to help shrink the cancer or relieve symptoms. However, chemotherapy tends to be less effective in the blast phase than in earlier phases.
If your condition responds well to treatment with medication, your doctor may recommend a stem cell transplant. However, this treatment also tends to be less effective in the blast phase.
In addition to the treatments described above, your doctor may prescribe therapies to help relieve symptoms or treat potential complications of CML.
For example, they may prescribe:
- a procedure known as leukapheresis to remove white blood cells from your blood
- growth factors to promote bone marrow recovery, if you go through chemotherapy
- surgery to remove your spleen, if it becomes enlarged
- radiation therapy, if you develop an enlarged spleen or bone pain
- antibiotic, antiviral, or antifungal medications, if you develop any infections
- blood or plasma transfusions
They may also recommend counseling or other mental health support, if you’re finding it difficult to cope with the social or emotional effects of your condition.
In some cases, they might encourage you to enroll in a clinical trial to receive experimental treatment for CML. New treatments are currently being developed and tested for this disease.
When you’re undergoing treatment for CML, your doctor may order regular blood tests to monitor how your body is responding.
If your current treatment plan appears to be working well, your doctor will likely advise you to continue with that plan.
If your current treatment doesn’t appear to be working well or has become less effective over time, your doctor may prescribe different medications or other treatments.
Most people with CML need to take a TKI for several years or indefinitely.
If you have CML, your doctor’s recommended treatment plan will depend on the phase of the disease, as well as your age, overall health, and history of past treatments.
Several treatments are available to help slow the growth of the cancer, shrink tumors, and relieve symptoms. Treatment tends to become less effective as the disease progresses.
Talk to your doctor to learn more about your treatment options, including the potential benefits and risks of different treatment approaches.