Supportive treatments for chronic myeloid leukaemia (CML)
Chronic myeloid leukaemia (CML) and its treatment can cause symptoms and problems. Supportive treatments can help to either prevent or control these problems.
The problems or symptoms you have depend on how the CML is affecting your body. And it also depends on what treatment you have.
You might have treatments for the following problems:
- high
white blood cell 
count - preventing
tumour lysis syndrome - treating and preventing infections
blood transfusions for low levels red blood cells platelet transfusions for low levels of platelets
High white blood cell count
You might have very high numbers of leukaemia cells in the blood when you are diagnosed with CML. This can cause problems with normal circulation.
The doctors will want to lower your count quickly. They might suggest you take a chemotherapy drug called hydroxyurea whilst they are waiting to find out what type of leukaemia you have. This drug lowers the number of leukaemia cells in your blood. This can help stop problems due to a high white blood cell count.
You gradually stop taking the hydroxyurea when you start your CML treatment.
Preventing tumour lysis syndrome
Tumour lysis syndrome (TLS) can be a serious complication of having cancer drugs for leukaemia. It can happen when the drugs kill large numbers of cancer cells very quickly.
When the body breaks down these dead cells they release large amounts of substances into the bloodstream. This can cause problems with your kidneys, heart and other areas of the body.
You will have frequent blood tests to closely monitor this. It’s important to drink plenty of fluids. Your doctor might give you more fluids as a drip into your bloodstream. You might also have medicines such as allopurinol to help keep the levels of in your blood stable.
Treating infections
CML and its treatment affect your . So you might be at risk of getting infections. But for most people, infections are not a common problem.
It’s important to tell your hospital treatment team immediately if you have any signs of infection.
Symptoms include:
- a change in temperature
- aching muscles
- headaches
- feeling cold and shivery and generally unwell
You might have other symptoms depending on where the infection is.
For some infections you can have treatment at home. But other infections can be life threatening, and you will need treatment in hospital.
Treatment for infection includes:
- antibiotics which treat bacterial infections
- antiviral drugs which treat viral infections
- antifungal drugs which treat infection caused by a fungal infection
Preventing infections
Vaccines are a way of protecting you against certain infections. Your doctor is likely to suggest that you have:
- a yearly flu vaccine
- a coronavirus (covid) vaccine
There might be other immunisations they recommend, talk to your doctor or specialist nurse about this.
Blood products
You might need to have a blood transfusion or platelet transfusion. This is because your might not make enough red blood cells or platelets. This isn't a common problem for people with CML.
You should only have blood or platelets that are first treated with radiation (irradiated) following treatment with the chemotherapy drug fludarabine. The radiation kills any white cells in the blood products. This protects you from a rare reaction to the blood cells. You should carry a card or wear a bracelet to make doctors and nurses aware of this. This is important in case of an emergency.
Blood transfusion
A low red blood cell count is called anaemia. You can feel very tired and have little or no energy. You might also feel breathless when you move around. Your doctor will check your blood counts.
You can have a blood transfusion if you are anaemic. This can help you to feel better.
Some people have a reaction to the blood, although this is rare. Tell your doctor or nurse if you feel hot or cold and shivery during the infusion. Your nurse will give you medicines to reduce the reaction.
Platelet transfusion
You might have low platelet levels. Platelets help the blood to clot. A low platelet level means you are at risk of bleeding. Tell your nurse or doctor straight away if you have any signs of unusual bleeding, such as:
- blood when you wee or when you have a poo
- bruises or tiny red spots on your skin
- nosebleeds
You might need a platelet transfusion.
Some people have a reaction to the platelets. This can make you feel hot or very cold and shivery when you are having the transfusion. Tell your doctor or nurse if you have this. They will give you medicines to reduce the reaction.
