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 tablets or capsules.

Treating blast phase CML

Blast phase CML is where your CML transforms to an acute leukaemia . The drugs you have for the blast phase CML depends on the type of leukaemia your CML develops into.

CML most commonly transforms into acute myeloid leukaemia (AML). So the chemotherapy treatment you have is the same chemotherapy treatment as AML.

The second most common transformation is acute lymphoblastic leukaemia (ALL). So if you have this type you have the same chemotherapy treatment as ALL.

There are other types of acute leukaemia and treatments are similar to AML and ALL. Transformation to these types of leukaemia are rarer.

Chemotherapy for AML and ALL is usually a combination of chemotherapy drugs. You usually have these as a drip into your bloodstream. You also take a tyrosine kinase inhibitor (TKI) drug alongside the chemotherapy.

Chemotherapy before a stem cell transplant

Your doctor might suggest high dose chemotherapy treatment followed by a stem cell 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 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

Chemotherapy for leukaemia treatment comes in many different forms. These include tablets or capsules that you take by mouth, or a drip into your bloodstream (intravenous). You might also have it as an injection into the fluid around the spinal cord and brain.

Chemotherapy into a vein

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

Taking your capsules or tablets

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 a cancer drug, or if you have missed a dose.

If you are sick after taking chemotherapy tablets or capsules, don’t take them again straight away. Talk to your medical team for advice if you miss a dose of a cancer drug or want to stop taking treatment for any reason.

Chemotherapy into the fluid around the spinal cord and brain

You have intrathecal chemotherapy in the same way you have a lumbar puncture. You lie on your side. Your doctor gives you a small injection to numb an area in your back. They then inject the drug between 2 of your spinal bones into the spinal fluid. It takes from 1 to 5 minutes. Afterwards you need to lie flat for an hour.

Not everyone gets this and it depends on the type of leukaemia your CML has transformed into. 

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.

Watch this video about what happens when you have chemotherapy. It is almost 3 minutes long.

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

Chemotherapy for CML can cause side effects and these can vary from person to person. It depends on the chemotherapy drugs, the dose you have and if you have them with other cancer drugs. Some of the common side effects include:

• an increased risk of infection
• breathlessness and looking pale
• bruising, bleeding gums or nose bleeds
• feeling or being sick
• diarrhoea
• tiredness and weakness
• hair thinning or loss
• sore mouth and ulcers
• loss of appetite
• losing weight
• tumour lysis syndrome - this is when there are changes to the levels of substances in your blood due to the breakdown of cancer cells. It usually happens when you first start treatment

Support at 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.