Leukemia--Chronic Myeloid (Myelogenous) Overview

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Treating Leukemia - Chronic Myeloid (CML) TOPICS

Treatment of chronic myeloid leukemia by phase

Treatment choices for people with chronic myeloid leukemia (CML) depend on the phase of the disease, their age, other prognostic factors, and whether there is a matched donor.

Chronic phase

The standard treatment for chronic phase CML is one of the targeted drugs like imatinib (Gleevec). Often, imatinib is the first drug tried. Some people in the chronic phase may be treated with a stem cell transplant from a matched donor.

Watching the patient's blood and bone marrow for a response is a very important part of treatment with a targeted therapy drug. Blood counts and special blood tests are watched closely – usually about every 3 to 6 months at first.

If the CML doesn’t respond well (or if it gets worse), after treatment with the first targeted drug there are several options:

  • Increasing the dose of the targeted drug.
  • Switching to one of the other targeted drugs (like from imatinib to dasatinib/Sprycel, nilotinib/Tasigna, or bosutinib/Bosulif). This helps many people for whom the first drug is not working.
  • For those who can't take these drugs or for whom they are not working, interferon or chemo may be an option.
  • Stem cell transplant may be an option, especially for younger people who have a donor with a matching tissue type.

Accelerated phase

During this phase, leukemia cells begin to build up in the body more quickly. Treatment choices depend on what treatments the patient has already had and are much like those used in the chronic phase. Higher doses of the targeted therapy drug being used may help. The patient may instead be switched to another targeted therapy drug. For the most part, patients in this phase are less likely to have a long remission with any treatment.

A stem cell transplant may be the best option for most patients who are young enough. Most doctors prefer that the leukemia be in remission before starting the transplant procedure. To achieve this, chemotherapy (chemo) will often be used. In some cases, a stem cell transplant using the patient's own stem cells may be an option to try to get the CML back into the chronic phase, but it is not likely to result in a cure.

Blast phase

In this phase of CML, the leukemia cells are more abnormal. The disease acts more like an acute leukemia. Treatments are the same as for patients in accelerated phase. Stem cell transplant from a donor rarely works for blast phase CML. But it is more likely to work if the CML can be brought back to the chronic phase before the transplant.

Most often, the leukemia cells act like cells of acute myeloid leukemia (AML), but often they don't respond to the chemo drugs used to treat AML. When the leukemia does respond to chemo, the response is usually short-lived, but it may give time for a stem cell transplant to be done.

A small number of patients in this phase have blast cells that look like those of acute lymphocytic leukemia (ALL). These cells respond better to chemo and about half of these patients may have a remission.

Treatment to relieve symptoms (called palliative treatment) is an important part of care for patients in this phase. Radiation treatment can help bone pain, and chemo may relieve some symptoms for a few months. In many cases, the effects of CML that has spread to the nervous system can be relieved by chemo or by radiation to the brain. Clinical trials are another option.

For more detailed information about treatment of CML, see our document Leukemia: Chronic Myeloid.

Last Medical Review: 08/13/2013
Last Revised: 02/10/2014