Chronic myeloid leukemia

Treatment

Several drugs have been approved to treat chronic myeloid leukemia (CML) since 2001. Given the number choices, it’s important to get treatment at a specialized center with CML expertise, like Seattle Cancer Care Alliance (SCCA).

Our experts offer comprehensive CML care, including advanced therapies available only through clinical studies, and we have detailed knowledge about the efficacy and side effects of each treatment option.

A diagnosis of cancer can feel overwhelming. We have an experienced, compassionate team ready to help. 

CML expertise at SCCA

Everything you need is here

We have medical oncologists and hematologists who specialize in CML; the most advanced diagnostic, treatment and recovery programs; and extensive support.

Innovative leukemia therapies

SCCA is a world leader in leukemia research. Our doctors and scientists pioneered a very important leukemia treatment — bone marrow transplant — and we advance new therapies every day.

CML treatment tailored to you

We view treatment as a collaborative effort. Your SCCA doctor will explain all your options and recommend a treatment plan based on your age, health and therapeutic goals.

Team-based approach

Your personal team includes an oncologist, nurse case manager and team coordinator. Additional experts who specialize in treating people with cancer will be involved if you need them — experts like an infectious disease doctor, pulmonologist, palliative care professional, geneticist, social worker, physical therapist or dietitian.

Learn More About Our Supportive Care Services

Ongoing care and support

During and after treatment, your team continues to provide follow-up care on a schedule tailored to you. The SCCA Survivorship Clinic is also here to help you live your healthiest life as a CML survivor.

Learn More About the SCCA Survivorship Clinic

Treatment by CML phase

Your treatment options depend on the phase of your disease as well as other factors.

Treating chronic-phase CML

Most people with CML are diagnosed in the chronic phase of the disease and treated with targeted therapy. If your disease responds well, you may stay on this treatment indefinitely.

Treating accelerated-phase CML

Your treatment will depend on whether your disease progressed to the accelerated phase after you started treatment or you were in the accelerated or blast phase when you were diagnosed. Treatment options include targeted drugs, chemotherapy or bone marrow transplant.

Treating blast-phase CML

Blast-phase CML acts like acute leukemia. It may be treated with targeted drugs plus induction chemotherapy (like that used for acute myeloid leukemia or acute lymphoblastic leukemia) or with high-dose targeted drugs alone. If your disease responds, your doctor may recommend a bone marrow transplant.

Treating relapsed CML

People whose CML returns or progresses after remission (relapsed CML) will typically be treated with a different targeted drug than they’ve already had. Your doctor may also recommend chemotherapy or a bone marrow transplant.

Monitoring CML treatment results

It is important to monitor how well your treatment is working, especially early on. If your disease is not responding well or it progresses or the side effects are too intense, you may need to switch to a different drug or different type of treatment.

Your doctor will check your blood and bone marrow regularly. They will be looking for these responses: 

  • Your blood cell counts and spleen size have returned to normal (hematologic response). Most people have this response within three months of starting therapy.
  • Your marrow is responding to treatment (cytogenetic response) — measured by checking for a decrease in or absence of the Philadelphia chromosome found in CML. Complete cytogenetic response typically occurs within six to 12 months.
  • The amount of BCR-ABL in your blood is 0.1 percent or less (major molecular response). This typically occurs within 12 to 18 months.
Targeted therapy

Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy. They target a gene or protein responsible for allowing cancer to grow, they seek out and damage cancer cells or they prompt your immune system to attack particular cells (also called immunotherapy).

Therapies called Abelson tyrosine kinase inhibitors (ABL TKIs) are the standard treatment for CML. They block the leukemia-causing effects of the protein made by the BCR-ABL gene — an abnormal gene in the Philadelphia chromosome.

Your SCCA team will talk with you about the specific drugs we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and connect you with medical and support resources throughout SCCA.

These are the targeted therapy drugs doctors may use for CML:

  • Bosutinib (Bosulif)
  • Dasatinib (Sprycel)
  • Imatinib (Gleevec)
  • Nilotinib (Tasigna)
  • Ponatinib (Iclusig)
Targeted therapy

Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy. They target a gene or protein responsible for allowing cancer to grow, they seek out and damage cancer cells or they prompt your immune system to attack particular cells (also called immunotherapy).

Chemotherapy

Chemotherapy was once a primary treatment for CML. Since the introduction of targeted therapies, chemotherapy is typically used only for blast-phase CML or as part of a bone marrow transplant.

Most chemotherapy drugs for CML are given by an infusion through an intravenous (IV) line. They may be used alone or in combination with other chemotherapy drugs.

Some of the chemotherapy drugs used to treat CML include:

  • Busulfan (Busulfex, Myleran)
  • Cyclophosphamide (Clafen, Cytoxan, Neosar, Revimmune)
  • Cytarabine (Cytosar, Tarabine)
  • Hydroxyurea (Droxia, Hydrea)
  • Omacetaxine (Synribo)
  • Vincristine (Vincasar)
Chemotherapy

Chemotherapy was once a primary treatment for CML. Since the introduction of targeted therapies, chemotherapy is typically used only for blast-phase CML or as part of a bone marrow transplant.

Interferon

Before effective targeted therapies, interferon was the standard of care for CML. Now it’s rarely used, but it may be an option for some people. Interferon-alpha (IFN-α) is a protein that interacts with receptors on the surface of cells. It stops cancer cells from dividing and stimulates your immune system to fight the cancer.

Interferon

Before effective targeted therapies, interferon was the standard of care for CML. Now it’s rarely used, but it may be an option for some people. 

Bone marrow transplant

Your doctors may recommend a bone marrow transplant (also called stem cell or hematopoietic cell transplant) to cure CML — typically only if:

  • Your disease has progressed.
  • Your disease is not responding to standard treatments.
  • You have accelerated- or blast-phase CML.

For CML, doctors perform a transplant using stem cells from a donor (allogeneic transplant). (For other diseases, they may use the patient’s own stem cells.) The transplant works in two ways.

  1. After you receive strong chemotherapy to eliminate the CML, the donor’s healthy stem cells restart your body’s ability to form blood cells.
  2. White blood cells from the donor may recognize as foreign and attack any leukemia cells that remain in your body (graft-versus-leukemia effect). 

More people are eligible for allogeneic transplants than ever before, due to advances available at SCCA, such as:

  • Non-myeloablative (reduced-intensity) transplants, which use lower-dose chemotherapy
  • Transplants using stem cells from donated umbilical cord blood or haploidentical (half-matched) donors
Bone marrow transplant

Your doctors may recommend a bone marrow transplant (also called stem cell or hematopoietic cell transplant) to cure CML.

Treating CML after a transplant

If a bone marrow transplant doesn’t cure your CML, your SCCA team may recommend other options, such as:

  • Having lymphocytes (a type of white blood cell) from the transplant donor infused into your bloodstream to stimulate the graft-versus-leukemia effect 
  • Using immunotherapy (interferon) or targeted therapy to treat your disease