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Biological therapies for chronic myeloid leukaemia (CML)

Men and women discussing chronic myeloid leukaemia

This page tells you about biological therapies for chronic myeloid leukaemia (CML). There is information about

 

A quick guide to what's on this page

Biological therapies for chronic myeloid leukaemia (CML)

Biological therapies are treatments that act on processes in cells or change the way that cells signal to each other. They can stimulate the body to attack or control the growth of cancer cells. A biological therapy called imatinib (Glivec) is the main treatment for most people with CML. It can keep the CML under control for many years. The main side effects are a skin rash, fluid build up, muscle cramps and feeling sick. Another biological therapy called nilotinib may also be used. Dasatinib may be used if imatinib stops working. Newer drugs such as ponatinib and bosutinib are also being developed and used in clinical trials.

Interferon for CML

Interferon is a type of biological therapy that stimulates the immune system to attack the leukaemia cells. You may have it if you can't have other biological therapies for any reason. Or your doctor may suggest it if you have had a bone marrow transplant or stem cell transplant for CML, but your leukaemia comes back. Interferon treatment may be combined with chemotherapy. The most common side effects of interferon are a reaction similar to flu, with aching, a high temperature and weakness. You may also feel sick or lose your appetite. Some people have depression and mood changes. All side effects tend to be more severe in older people.
 

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Imatinib (Glivec) for CML

Imatinib (Glivec) is the main treatment for most people with chronic myeloid leukaemia. It is a type of biological treatment that blocks cancer cell growth. Doctors call this type of drug a tyrosine kinase inhibitor. It blocks a protein made by CML cells. Imatinib can keep CML under control for many years.

Most people with CML have a gene mutation called the Philadelphia chromosome. The gene is called the bcr/abl gene. It carries the instructions for the body to make an abnormal protein (the bcr/abl protein). This protein signals to the body to make far too many white blood cells. Imatinib blocks this protein and stops the overproduction of white blood cells.

You take imatinib as tablets either once or twice a day, depending on the dose. You usually continue taking imatinib for as long as it works.

The main side effects are

  • Low resistance to infection
  • Bruising
  • Tiredness
  • A skin rash
  • Fluid build up
  • Muscle cramps
  • Feeling sick
  • Diarrhoea

There is detailed information about imatinib and its side effects of imatinib in the cancer treatments section.

 

Nilotinib (Tasigna)

Nilotinib is another type of cancer growth blocker. It works in a similar way to imatinib. If imatinib doesn't work or stops working because the leukaemia cells have become resistant to it, nilotinib can get the CML into remission again. Some people have nilotinib as a first treatment for chronic phase CML. 

Nilotinib comes as red capsules. You usually take 2 capsules twice a day, 12 hours apart. You should not take them with food. You need to take them at least 2 hours before you eat and at least 1 hour after eating.

The possible side effects include

  • An increased risk of infection
  • Bruising
  • Tiredness
  • Skin rashes
  • Feeling sick
  • Headaches

You can find detailed information about nilotinib and its side effects in the cancer drugs section. 

 

Dasatinib (Sprycel)

Dasatinib (Sprycel) is another type of cancer growth blocker. You may have it if you have had imatinib or nilotinib and they have stopped working or if they cause too many side effects.  

Dasatinib comes as tablets that you take either once or twice a day. You usually carry on taking it for as long as it works, unless the side effects get too bad. Dasatinib can interact with some other drugs and herbal remedies. It is important to tell your doctor if you are taking any other medicines.

The possible side effects include

  • Low resistance to infection
  • Tiredness
  • Bruising more easily
  • Diarrhoea
  • Headaches
  • A cough or breathlessness due to fluid around the lungs
  • Skin rashes or red, dry, itchy skin
  • Fluid build up in the body
  • Depression
  • Feeling or being sick

There is detailed information about dasatinib and its possible side effects in the cancer drugs section.

 

Interferon alpha for CML

Interferon is a type of biological therapy that can work well for chronic phase CML. It is usually used in the following situations 

  • If other types of biological therapy do not work or stop working after a while
  • If other types of biological therapy cause too many side effects
  • If you had a bone marrow or stem cell transplant but your CML comes back. 

About 1 in 5 people have such a good response that there are no longer any Philadelphia chromosome positive cells found in their bloodstream or bone marrow. This response can be long lasting, sometimes for more than 10 years. You usually carry on with the interferon for at least 2 or 3 years.

You have interferon alpha treatment as daily injections, just under the skin. You, or someone you live with, can learn to give the injections at home. We have a video which shows how to give the injections. But if you don't like the thought of that, your district nurse or practice nurse could do it instead.

Interferon does have side effects but they vary a lot. Some people have very little trouble with interferon. Others find it very difficult to put up with. The most common side effects are a flu like reaction, with aching muscles, a high temperature and weakness. Paracetamol usually helps. You may also feel sick and lose your appetite.

Some people have more severe side effects, with depression and mood changes. All side effects are likely to be more severe in older people.

 

Newer biological therapies for CML

Some people who have CML develop resistance to biological therapies that target the bcr/abl protein. Doctors are looking at a new tyrosine kinase inhibitors called ponatinib and bosutinib that target other proteins. So far, the clinical trials have looked promising in people who have already had other treatments for CML.

There is more information about newer biological therapies on our page about CML research.

 

Where to find more information

We have a section about biological therapies with detailed information about these treatments. There is information on the different types of biological therapies, including cancer growth blockers such as imatinib, nilotinib and dasatinib and immunotherapies such as interferon

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Updated: 26 April 2013