In the accelerated phase of chronic myelogenous leukemia (CML), the leukemia cells begin to build up more quickly and symptoms appear. New gene mutations are often acquired, which helps the leukemia cells grow and tends to make treatments less effective. The blood cell counts may be abnormal, the spleen may be enlarged and the person does not feel well.
The goal of treatment during this phase is to destroy all the cells that contain the BCR-ABL gene or to return the CML to the chronic phase. The treatment options are similar to those for the chronic phase. However, a long-term response to treatment is less likely.
Response to treatment is important and is closely monitored.
Stem cell transplant
A stem cell transplant may be offered for CML in the accelerated phase.
- Allogeneic transplant can bring about remission in some people.
- Doctors usually prefer that the leukemia returns to the chronic phase or is controlled before the transplant.
- Sometimes an autologous transplant is an option to try to return the CML to the chronic phase.
- A reduced-intensity transplant may be an option for older people who may not tolerate a standard transplant.
- The chemotherapy or radiation used to prepare for a stem cell transplant is less intense than that used for a standard allogeneic transplant.
Targeted therapy with a tyrosine kinase inhibitor may be offered during the accelerated phase of CML. For those already taking targeted therapy, the dose may be increased. The types of targeted therapy used are:
- imatinib (Gleevec)
- dasatinib (Sprycel)
Biological therapy may be offered for CML in the accelerated phase. The most common type of biological therapy used is interferon alfa (Intron A, Roferon A). Interferon alfa may be given in combination with cytarabine (Cytosar, Ara-C).
Chemotherapy may be offered for CML in the accelerated phase. The types of chemotherapy used are:
- cytarabine (Cytosar, Ara-C)
- HDAC (high-dose cytarabine)
- hydroxyurea (Hydrea, Gen-hydroxyurea, Apo-hydroxyurea)
- busulfan (Myleran [oral], Busulfex [intravenous])
People with CML may be offered the opportunity to participate in clinical trials. For more information, go to clinical trials.