Chronic Myeloid Leukemia (CML): Treatment Choices
There are various treatment choices for chronic myeloid leukemia (CML). Which one may work best for you? It depends on a number of factors. These include:
The phase of your CML
Results of your tests
Whether the CML is causing symptoms
Your age and overall health
What side effects you’ll find acceptable
Learning about your treatment options
You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.
Your healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may suggest a specific treatment. Or he or she may offer more than one treatment option, and ask you to decide which one you’d like to use. It can be hard to make this decision. It is important to take the time you need to make the best decision for you.
Types of treatment for CML
Targeted therapy. These are medicines that take aim on abnormal proteins on the leukemia (cancer) cells, such as those caused by the Philadelphia chromosome.These medicines are most effective in treating early stages of CML. These are often the first treatment. The medicines include imatinib, dasatinib, nilotinib, bosutinib, and ponatinib. These are medicines called tyrosine kinase inhibitors (TKIs). They block the abnormal protein found in CML cells. The medicines can work for long periods of time. But they don’t cure CML. They must be taken continuously.
Stem cell transplant. This treatment is sometimes used for CML, especially in younger people, because it offers the best chance for a cure. This is most often an option if other treatments such as targeted therapy are not working. Before the transplant, you get high doses of strong medicines called chemotherapy. And sometimes, you'll get radiation therapy. This is done to destroy almost all your bone marrow. Then stem cells from a healthy donor are used to replace your bone marrow. The cells from the donor may also help eliminate the disease.
Immunotherapy. This treatment uses medicine to help your immune system fight leukemia. Interferon is the most common type of immunotherapy medicine used to treat CML. It’s used less often now than in the past. This is because targeted therapy is more common.
Chemotherapy. This treatment uses strong medicines to kill cancer cells.This is not a common treatment for CML. Its goal is to kill the cancer cells and put the cancer into remission. Remission means there are no signs of cancer in the body. The most common medicine used for CML is hydroxyurea. It can control the number of leukemia cells. But it can’t cure the disease. Other medicines can be tried as well, such as omacetaxine mepesuccinate.
Radiation therapy. This type of therapy uses strong X-rays to kill cancer cells. It can be used to kill leukemia cells that have spread to an organ, such as your spleen. It’s a less common treatment for CML.
Surgery. A splenectomy is surgery to take out your spleen. Your spleen may be removed to improve blood cell counts or to reduce pressure on other organs caused by a swollen spleen. Surgery is not often used for CML.
Clinical trials for new treatments
Researchers are always finding new ways to treat CML. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials you should think about.
Talking with your healthcare providers
At first, thinking about treatment options may seem overwhelming. Talk with your healthcare team and loved ones. Make a list of questions. Look at the benefits and possible side effects of each option. Discuss your concerns with your healthcare providers before making a decision.
June 13, 2018
Cunningham, Louise, RN,Levy, Adam S., MD