Types of treatment for chronic myeloid leukaemia
This page gives you an overview of the treatment for chronic myeloid leukaemia. There is information about
Which treatment for chronic myeloid leukaemia
The treatment of CML depends on the phase of the disease, your general health, your age and level of fitness.
Chronic phase CML
The most common treatment for chronic phase CML is a biological therapy drug called imatinib (Glivec). If imatinib doesn’t work for you or causes severe side effects, or the CML comes back, your doctor may recommend another biological therapy drug called nilotinib (Tasigna). If you can't have biological therapies for any reason, you might have chemotherapy to keep the CML under control. Or your doctor may suggest intensive treatment with a bone marrow transplant or stem cell transplant. This treatment is not suitable for everyone, but it can cure some people with CML.
For accelerated phase CML, imatinib is usually the first choice of treatment, unless you already had it in chronic phase. If you were taking imatinib in chronic phase and your CML has progressed to accelerated phase, it will not continue to help you. Your doctor may then suggest other biological therapy drugs such as nilotinib (Tasigna) or dasatinib (Sprycel). Or you may have chemotherapy. Or your doctor may suggest intensive treatment with a bone marrow transplant or stem cell transplant.
For blast phase CML, your doctor may suggest imatinib if you haven't had it before. Or they may suggest nilotinib or dasatinib. They may suggest chemotherapy with drugs that are usually used for acute leukaemia. Bone marrow transplant or stem cell transplant may also be an option. At this stage, treatment to cure symptoms may be important, such as radiotherapy to shrink an enlarged spleen or reduce pain in the bones. Chemotherapy may also reduce symptoms for a while.
You can view and print the quick guides for all the pages in the Treating CML section.
The main treatments for chronic myeloid leukaemia are the biological therapy drug Imatinib (Glivec), chemotherapy and intensive chemotherapy with a bone marrow or stem cell transplant.
The most important factor in choosing your treatment is the phase or stage of the CML. Your doctor will also take into account
- Your general health
- Your age and level of fitness
Researchers and doctors continue to look for better combinations of treatments, as well as new treatments. They test treatments in clinical trials. Your doctor may suggest that you join a trial. In our research section, there is information about clinical trials, including what it is like to take part. You can find details of individual trials for chronic leukaemia in our clinical trials database.
The most common treatment for chronic phase CML is a biological therapy drug called imatinib (Glivec). Most people respond well to this treatment and their CML stays under control for some years. Some people have CML that doesn't respond to this drug, or becomes resistant to it after a time. If imatinib doesn’t work for you or causes severe side effects, your doctor may recommend another biological therapy drug called nilotinib (Tasigna).
If you can't have imatinib or nilotinib for any reason, you might have chemotherapy to keep the CML under control.
Your doctor may suggest intensive treatment with a bone marrow transplant or stem cell transplant. This treatment is not suitable for everyone. Your doctor will take your age and general fitness into account. Intensive treatments are too risky if you are not fit enough to get through them. There is a possibility that you could die from infection during the treatment, rather than from your leukaemia. Generally you have to be under about 65 to have this intensive treatment, but some people who are older but very fit and healthy may be able to have it.
The treatment for accelerated phase CML depends on the treatment you have already had. Imatinib (Glivec) is usually the first choice of treatment, unless you already had it in chronic phase. In people who haven't had it before, imatinib gets about 20 out of every 100 people (20%) back into the more stable chronic phase of CML. It may be used in higher doses than with chronic phase CML.
If you have already had imatinib or it is not working, your doctor may suggest other similar drugs such as nilotinib (Tasigna) or dasatinib (Sprycel). Or you may have chemotherapy. If you are young, fairly fit and have a relative who can be a donor, your doctor may suggest intensive treatment with a bone marrow transplant or stem cell transplant.
You may have blood transfusions to boost your blood cell count if you are anaemic.
If you have blast phase CML, your doctor may suggest imatinib if you haven't had it before. Or they may suggest nilotinib or dasatinib. Or they may suggest chemotherapy with a combination of drugs that is usually used for acute leukaemia. This is because your leukaemia is developing more quickly like an acute leukaemia. The aim of your treatment is to try to get the disease back into chronic phase and improve your symptoms.
A bone marrow transplant or stem cell transplant may also be an option. At this stage, other treatments to get rid of symptoms may be important, such as radiotherapy to shrink an enlarged spleen or reduce pain in the bones.
It's important that you feel OK about the treatment your specialist recommends. Most people feel more comfortable about this if they understand why a particular treatment decision has been made. This can be even more important if you've been told that a particular treatment isn't suitable for you. These days, most doctors expect patients to want to ask questions and they appreciate that you need things explained in a way you can understand.
Your doctor won't give any treatment without your permission (consent). In some situations you may feel that you don't want to have treatment, for example if the treatment has only a small chance of helping you and may cause bad side effects. Your doctor can explain what will happen if you don't have the treatment and they will go along with your wishes.
An appointment where you are given your diagnosis and told about your treatment options is very important. You are likely to be shocked and might find it hard to take in information or make decisions. When you go to see the doctor it often helps to write down a list of questions you want to ask.
You could take a close friend or relative with you to the appointment. They can help you to remember what is said. If you feel that you need more time to think things through or discuss the options, you can ask your specialist to see you again to discuss things more fully before you make a decision. There are also specialist nurses you can talk to who can answer questions about your cancer and its treatment.
Our chronic leukaemia organisations page gives details of people who can provide information about your choice of treatment. Some organisations can put you in touch with a cancer support group. You can find details of counselling organisations in our counselling section. Our chronic leukaemia reading list has information about books and leaflets on CML treatments.
If you want to find people to share experiences with online, you could use CancerChat, our online forum. Or you can go through My Wavelength. This is a free service that aims to put people with similar medical conditions in touch with each other.
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