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Treatments for CML in the accelerated phase
The following are treatment options for chronic myelogenous leukemia (CML) in the accelerated phase. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.
In the accelerated phase the leukemia cells begin to build up more quickly and symptoms appear. Leukemia cells often change, or mutate. These changes help the leukemia cells grow and tend to make treatments less effective. The blood cell counts may be higher or lower than normal, the spleen may be larger than normal (enlarged) and you will not feel well.
The goal of treatment during the accelerated phase is to return the CML to the chronic phase. Your healthcare team will check your blood and bone marrow to closely monitor the response to treatment.
Targeted therapy with a tyrosine kinase inhibitor may be offered during the accelerated phase of CML. If you are already taking targeted therapy, your doctors may increase the dose of the drug or try a different drug. The following targeted therapy drugs are used for CML in the accelerated phase.
Imatinib (Gleevec) is the standard first-line therapy.
Dasatinib (Sprycel) or nilotinib (Tasigna) may be given as a first-line therapy. They may also be given if someone cannot cope with the side effects of imatinib or if CML is resistant to imatinib.
Bosutinib (Bosulif) may be given if someone cannot cope with the side effects of imatinib, dasatinib or nilotinib. Bosutinib is also used if the CML is resistant to these drugs.
Pontatinib (Iclusig) may be given if the CML is resistant to other targeted therapies or if the leukemia cells have a certain gene mutation.
Stem cell transplant
A stem cell transplant may be offered for CML in the accelerated phase. Doctors will usually try to get CML to return to the chronic phase or improve the blood cell counts before the transplant.
An allogeneic stem cell transplant is preferred because sometimes it can bring about remission, which means that the blood cell counts have returned to normal and stay at or near normal levels for a long period of time. But this type of transplant can only be done if a matched donor is available.
If an allogeneic transplant can’t be done, an autologous stem cell transplant may be done to try to return the CML to the chronic phase but this is very uncommon at present.
A reduced-intensity transplant may be an option for older people or for people who are not healthy enough to cope with the side effects that happen with a standard transplant. A reduced-intensity transplant uses less intense chemotherapy or radiation therapy to prepare for the stem cell transplant.
Biological therapy may be offered for CML in the accelerated phase. It may be offered to people who cannot cope with the side effects from, or if the CML is resistant to, targeted therapy. Biological therapy can be used alone or in combination with chemotherapy.
The most common biological therapy used is interferon alfa (Intron A, Wellferon).
Chemotherapy may be offered for CML in the accelerated phase if someone cannot cope with the side effects from targeted therapy or the CML is resistant to targeted therapy. Chemotherapy is also used in preparation for a stem cell transplant.
The chemotherapy drugs used to treat CML in the accelerated phase are:
- cytarabine (Cytosar, Ara-C)
- high-dose cytarabine (HDAC)
- hydroxyurea (Hydrea)
- busulfan (Myleran [oral], Busulfex [intravenous])
Supportive therapy is important during treatment for every phase of CML. It is used to treat the complications that usually happen with treatments for CML and the disease itself.
Supportive therapies given during the accelerated phase may include:
- antibiotics, antivirals or antifungals to prevent or fight infections
- growth factors to help the bone marrow recover from chemotherapy (chemotherapy can affect the bone marrow so it doesn’t make enough healthy blood cells, which can increase the risk for infection)
- transfusions of red blood cells, platelets, fresh frozen plasma and cryoprecipitate (a product that replaces clotting factors) as needed
- drugs to bring down high levels of some chemicals in the blood that increase when many cancer cells die at the beginning of treatment (called tumour lysis syndrome)
- leukapheresis to remove large numbers of white blood cells from the blood
You may be asked if you want to join a clinical trial for CML. Find out more about clinical trials.
Referring to DNA, cells, tissues or organs taken (harvested) from a donor to be given to a recipient who is a close, but not identical, genetic match.
For example, an allogeneic stem cell transplant takes blood or bone marrow from a donor (usually a first-degree relative) and gives it to a recipient.
Referring to DNA, cells, tissues or organs taken (harvested) from a person’s own body to be stored and given back to the same person.
For example, in an autologous stem cell transplant, blood or bone marrow is taken from a person, stored and later given back to the same person.
Autologous transplant is also called autotransplant or autograft.
A procedure that uses a special machine (pheresis machine) to separate and collect specific white blood cells from withdrawn blood. The remaining blood is then returned to the body.
Leukapheresis is used to lower a very high white blood cell count in people with cancer (leukemia) or to remove white blood cells for transfusion.