Types of treatment for chronic myeloid leukaemia

The treatment for chronic myeloid leukaemia varies depending on

• The stage of the CML
• 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 you join a trial. In CancerHelp UK's research section, there is information about clinical trials, including what it is like to take part. You can find details of individual trials in the CancerHelp UK clinical trials database. Choose 'leukaemia: chronic leukaemia' from the dropdown menu of cancer types.

The preferred treatment for chronic phase CML is imatinib (Glivec) Imatinib is a type of biological therapy. 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, there are other newer biological therapies, called dasatinib and nilotinib. Or you might have chemotherapy or biological therapy with interferon to keep the CML under control.

Your doctor may suggest intensive treatment with bone marrow or stem call transplant. This treatment is not suitable for everyone, but it can cure some people with CML. 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 very fit and healthy may be able to have it.

For accelerated phase CML, imatinib (Glivec) is usually the first choice of treatment. In those 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. Generally you can only have Glivec if you didn't have it in chronic phase. If your CML progressed from chronic phase into accelerated phase while you were taking imatinib, there is no evidence that it will continue to help you. But if you had a stem cell transplant and your CML came back, you can have imatinib again even if you had it before your transplant.

Another option is a newer biological therapy called dasatinib.

Your doctor may suggest intensive treatment with a bone marrow or stem cell transplant if you have not had one and it is a suitable treatment for you. Otherwise you'll have chemotherapy. 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 chemotherapy with a combination of drugs that is usually used for acute leukaemia. This is because your leukaemia is developing more quickly. The aim of your treatment is to try to get the disease back into chronic phase and improve your symptoms.

Doctors are developing new drugs similar to imatinib (Glivec). These can help when people have developed resistance to imatinib. Resistance means that the drug is no longer working. The newer drugs may also be more powerful. One of these newer drugs is dasatinib. It was licensed for treating CML in Europe in November 2006. Dasatinib is licensed for people who cannot have imatinib because of side effects, or who have had imatinib and their CML has not responded. 

In May 2007, the Scottish Medicines Consortium (SMC) approved dasatinib for use on the NHS in Scotland, but only for people in chronic phase CML. Dasatinib hasn't yet been approved by the National Institute for Health And Clinical Excellence (NICE) for use on the NHS in England and Wales.

Another new biological therapy is nilotinib. Clinical trials in newly diagnosed chronic phase patients have shown quicker and better responses with nilotinib than with other biological therapies. In August 201, the SMC approved the use of nilotinib for adults with newly diagnosed Philadelphia chromosome positive in the chronic phase. Nilotinib has not yet been assessed by NICE. So you are most likely to be offered nilotinib as part of a clinical trial. There is more information about nilotinib in our cancer drugs section.

There is also more information on our CML research page.