Chemotherapy for chronic myeloid leukemia

Chemotherapy uses drugs to destroy cancer cells. These drugs target rapidly dividing cells throughout the whole body. This means that chemotherapy kills cancer cells but it can also damage healthy cells.

With most types of chemotherapy, the drugs travel through the blood to reach and destroy cancer cells all over the body, including leukemia cells in the blood. This is described as systematic therapy.

Chemotherapy is rarely used to treat chronic myeloid leukemia (CML) because targeted therapy with tyrosine kinase inhibitors (TKIs) is much better at treating and controlling the disease.

You may be offered chemotherapy to:

• relieve symptoms before the healthcare team confirms a diagnosis of CML
• prepare for a stem cell transplant
• treat CML that changes to look like acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL)
• treat refractory CML

Your healthcare team may offer chemotherapy to treat symptoms while they are waiting to confirm a CML diagnosis. The drug hydroxyurea can be used to lower your blood cell counts.

Chemotherapy may also be offered if CML changes during the blast phase. The blast cells in the blood and bone marrow may have developed changes in addition to the BCR-ABL gene. These changes are called additional chromosomal abnormalities (ACAs). They can make the blast cells look more like the immature cells found in acute leukemia. Your healthcare team may order blood or bone marrow tests to see what type of cells and ACAs are now present.

If CML changes to look like acute leukemia, your healthcare team may offer you chemotherapy along with a TKI. The type of drugs offered will depend on the changes in the blast cells.

Myeloid blast phase means that CML starts to look more like acute myeloid leukemia (AML). The most common combination of drugs offered is FLAG-IDA with either dasatinib (Sprycel) or ponatinib (Iclusig). FLAG-IDA is fludarabine (Fludara), cytarabine (Cytosar), filgrastim and idarubicin. Your healthcare team may offer other combinations of drugs. Find out more about chemotherapy for AML.

Lymphoid blast phase means that CML starts to look more like ALL. The most common combination of drugs offered is hyperfractionated CVAD (cyclophosphamide, vincristine, doxorubicin and dexamethasome) with either imatinib or dasatinib. Your healthcare team may offer other combinations of drugs. Find out more about chemotherapy for ALL.

Side effects of chemotherapy will depend mainly on the type of drug, the dose, how it’s given and your overall health. Tell your healthcare team if you have side effects that you think are from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

The side effects of hydroxyurea are:

• nausea and vomiting
• diarrhea
• constipation
• stomach pain
• loss of appetite

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.

Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.