Treatments for chronic myeloid leukemia in the chronic phase

The goal of treatment for chronic myeloid leukemia (CML) in the chronic phase is to reduce the number of granulocytes with the BCR-ABL gene (leukemia cells or CML cells) that are in the blood. This is called a molecular response.

Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. During treatment they will check your blood to see how well CML is responding. Based on the results of these tests, your healthcare team may change your treatment.

Targeted therapy is the main treatment for CML in the chronic phase. In rare cases, you may be offered a stem cell transplant. Sometimes chemotherapy is used to treat symptoms before CML is diagnosed.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer. Targeted therapy is the main treatment for almost all people with CML in the chronic phase.

The targeted therapy drugs used to treat CML are called tyrosine kinase inhibitors (TKIs).

Imatinib (Gleevec) is the standard TKI given when CML is first treated. The dose may be increased after 3 months if CML doesn't respond (is resistant) to treatment.

Dasatinib (Sprycel) or nilotinib (Tasigna) may be given as an alternative to imatinib. They may also be given if the side effects of imatinib are severe or if CML doesn't respond to imatinib after 6 months.

Bosutinib (Bosulif) may be given if there are severe side effects from imatinib, dasatinib or nilotinib. Bosutinib is also used if CML doesn't respond to, or stops responding to, these TKIs after 6 months.

Ponatinib (Iclusig) may be given if CML doesn't respond to any of the other TKIs. It is also used if there are other gene mutations in addition to the BCR-ABL gene, such as the T315I gene mutation.

Find out more about targeted therapy for CML.

A stem cell transplant can be used to remove stem cells with the BCR-ABL gene and replace them with healthy ones. But it is a complex procedure and the side effects can be very serious. So a stem cell transplant is rarely used to treat CML in the chronic phase since TKIs became the standard treatment.

The type of stem cell transplant that may be offered is an allogeneic stem cell transplant with a matched donor.

A stem cell transplant is only offered to healthy people who have CML that doesn't respond to, or stops responding to, any of the TKI drugs. It may also be offered if you have very severe side effects from TKI drugs or if your blood cell counts do not return to normal.

Find out more about a stem cell transplant for CML.

In some cases, chemotherapy may be offered to treat symptoms while your healthcare team is waiting for test results to confirm a diagnosis of CML. The drug used is called hydroxyurea.

Find out more about chemotherapy for CML.

Talk to your doctor about clinical trials open to people with CML in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.