Decisions about your treatment

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The MDT look at a number of different factors including: 

• the phase of your CML
• your general health
• your age and level of fitness

Treatment overview

The main treatments for CML are:

• targeted cancer drugs
• chemotherapy
• stem cell or bone marrow transplant

Treatment by phase

Chronic phase

Targeted cancer drugs called tyrosine kinase inhibitors are the most common treatment for this phase, usually with a drug called imatinib (Glivec). Most people respond well to this treatment and the CML can stay under control for many years.

Imatinib might not work for some people, or it stops working after a period of time. In this situation your doctor might suggest another TKI. 

Occasionally TKI treatment does not work. In this situation chemotherapy and a stem cell transplant may be considered. 

For CML, you usually have a transplant using someone else’s (a donor’s) stem cells or bone marrow. This is called an allogeneic transplant.

Accelerated phase

The treatment for the accelerated phase depends on the treatment you have already had. Imatinib is normally the first choice unless you have already had it in the chronic phase.

Some people who have imatinib for the first time in the accelerated phase might have a good response to treatment. It might put their CML back into the more stable chronic phase for a time.

You might have treatment with another TKI. There are several available including, nilotinib (Tasigna), dasatinib (Sprycel), bosutinib (Bosulif) and ponatinib (Iclusig). 

Other treatment options include chemotherapy. Or your doctor might recommend more intensive treatment using a stem cell or bone marrow transplant. This is more likely if you are younger and fairly fit and well. 

Blast phase

Your doctor might suggest treatment with imatinib if you haven’t had it before. Or you might have another TKI. 

If the TKI does not work well then other treatment options include:

• chemotherapy with a combination of drugs that is usually used for acute leukaemia
• a stem cell or bone marrow transplant

Or you might have treatment to relieve symptoms. For example, radiotherapy to shrink an enlarged spleen. Or radiotherapy to reduce pain in the bones.

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.