Treatments for CML in the chronic phase
The following are treatment options for chronic myelogenous leukemia (CML) in the chronic phase. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.
Most people are diagnosed in the chronic phase of CML. The goal of treatment during the chronic phase is to return the blood cell counts to normal and keep them at or near normal levels for long periods of time (called remission).
Your healthcare team will check your blood and bone marrow to closely monitor the response to treatment.
Targeted therapy is the main treatment for most people with CML in the chronic phase. It is treatment that uses drugs or other substances to target specific molecules (usually proteins) involved in cancer cell growth while limiting harm to normal cells. The following targeted therapy drugs are used for CML in the chronic 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 because the leukemia cells, or blasts, have a certain gene mutation.
Stem cell transplant
An allogeneic stem cell transplant may be offered for CML in the chronic phrase. It may be used as the main treatment for younger people who have an HLA-matched donor. It is also a treatment option for some people who do not reach a complete response with, develop resistance to or relapse after targeted therapy or biological therapy with interferon alfa (Intron A, Wellferon).
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 chronic 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 chronic 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 chronic phase are:
- hydroxyurea (Hydrea)
- cytarabine (Cytosar, Ara-C), which may be used in combination with interferon alfa
- 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 chronic 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.
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.
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
Great progress has been made
Some cancers, such as thyroid and testicular, have survival rates of over 90%. Other cancers, such as pancreatic, brain and esophageal, continue to have very low survival rates.