Chemotherapy for chronic myeloid leukaemia (CML)

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

Targeted cancer drugs such as imatinib are usually the first treatment for most people with chronic myeloid leukaemia (CML). But some people might need to have chemotherapy. 

When you have it

You might have chemotherapy:

  • while you are waiting for test results to confirm your diagnosis - this is to reduce your white blood cell count or to control symptoms 
  • if your CML is in the blast phase 
  • before a stem cell transplant

Types of chemotherapy

Lowering your white blood cell count

You might have a chemotherapy drug called hydroxycarbamide. This aims to reduce your white blood cell count and control any symptoms you might be having. You take hydroxycarbamide as capsules.

Treating blast phase CML

The drugs you have for the blast phase of CML are the same as for acute myeloid leukaemia (AML). You usually have a combination of chemotherapy drugs into your bloodstream through a drip. You might take a tyrosine kinase inhibitor (TKI) drug alongside the chemotherapy.

High dose chemotherapy

Your doctor might suggest high dose chemotherapy treatment followed by a stem cell or bone marrow transplant. You might have this if your CML has not responded to previous treatment with tyrosine kinase inhibitors (TKIs). 

You need to:

  • be reasonably fit to have a stem cell or bone marrow transplant
  • go into hospital to have high dose chemotherapy through a drip

This treatment is intensive and not suitable for everyone. You have a high risk of picking up an infection afterwards and will need to stay in hospital for a few weeks at least.

How you have chemotherapy

You might take chemotherapy as capsules, or have it directly into your bloodstream (intravenously).

Taking your capsules or tablets

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking or miss a dose of a cancer drug.

Into your bloodstream

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test. 

Where you have chemotherapy

You can usually take chemotherapy capsules at home. Your doctor or pharmacist gives you instructions on when and how to take them.

You have treatment that goes into your bloodstream through a drip at the cancer day clinic or as an inpatient on the ward. It can take several hours to have chemotherapy so it’s a good idea to have something to read to help to pass the time. A friend or family member can usually be with you to keep you company.

Dietary or herbal supplements and chemotherapy

Let your doctors know if you:

  • take any supplements
  • have been prescribed anything by alternative or complementary therapy practitioners

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • increased risk of getting an infection
  • bleeding and bruising easily
  • diarrhoea or constipation
  • hair loss
Contact your doctor or nurse immediately if you have signs of infection. These include a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.

Side effects depend on:

  • which drugs you have
  • how much of each drug you have
  • how you react

Tell your treatment team about any side effects that you have.

When you go home

Chemotherapy for CML can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.

  • Chronic Myeloid Leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow up

    A. Hochhaus and others

    Annals of Oncology, 28, (Supplement 4) pages 41-51, 2017

  • Chronic myeloid leukaemia
    J Cortes and others
    Lancet 2021, Volume 398, issue 10314, pages 1914-1926

  • A British Society for Haematology Guideline on the diagnosis and management of chronic myeloid leukaemia
    G Smith and others
    British Journal  of  Haematology, 2020, volume 191 pages 171–193

  • European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia
    A. Hochhaus and others
    Leukemia (2020) Volume 34, pages 966–984

Last reviewed: 
22 Jul 2022
Next review due: 
22 Jul 2025

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