Treatment options by phase for chronic myeloid leukemia

The chronic phase is the earliest stage of CML.

In this phase, the cancer grows and spreads most slowly, and people typically experience few or no symptoms.

Moreover, during this stage of CML, people have less than 10% blast cells, which are cancerous immature white blood cells.

Most people receive a diagnosis of CML in the chronic phase.

Treatment options

During the chronic phase, the first line of treatment is tyrosine kinase inhibitors (TKIs). A doctor may try one or more TKIs, such as:

• nilotinib (Tasigna)
• imatinib (Gleevec)
• bosutinib (Bosulif)
• dasatinib (Sprycel)

If a specific TKI is ineffective, a doctor may change a person’s dose or use a different medication. On rare occasions, a doctor may recommend a bone marrow transplant.

Results and success from treatment

During treatment, a doctor will need to check the progress regularly. To do this, they will need to draw blood and check for levels of BCR-ABL, a cancer-causing gene, every 3–6 months. A person’s doctor should review the results of the tests with the person.

A 2017 long-term study found that the 10-year survival rate of people who received a diagnosis of chronic phase CML was about 83% when they took imatinib.

The American Cancer Society states that about 70% of people have a complete response to TKI treatments within the first year.

Options if first treatment does not work

If the first treatment does not prove effective, a doctor may consider the following:

• using interferon therapy or chemotherapy
• switching to a different TKI
• increasing the dose of the current drug
• performing a stem cell transplant, also known as bone marrow transplant

Treatment after stem cell transplant

Treatment following a stem cell transplant can vary based on the response a person’s body has to the transplant.

If the person’s body does not reject the transplant, a doctor may try to have the immune system attack the cancer cells by either reducing the amount of immunosuppressors or introducing donor cells.

The second phase of CML is the accelerated phase, during which blast counts are higher, and symptoms are likely to develop.

In addition, during this stage, a person has increased cancer activity.

According to the American Cancer Society, a doctor will often diagnose the accelerated phase if one or more of the following occur:

• very low platelet counts
• new chromosome changes in leukemia cells with the Philadelphia chromosome
• blood samples containing 15–30% blasts
• combined blasts and promyelocytes making up at least 30% of the blood
• blood containing 20% or more basophils

A person with accelerated phase CML is also more likely to experience symptoms such as:

• weight loss
• poor appetite
• fever

Treatment options

The American Cancer Society states treatment for the accelerated phase will be similar to that for the chronic phase. The main difference is that in the second phase of CML, long-term success with treatment is less likely.

Treatment options, which will depend on what doctors have already used, may include:

• starting a TKI
• increasing the dose or switching the type of TKI
• using interferons
• combining TKI with chemotherapy
• carrying out a stem cell transplant

Results and success from treatment

It is difficult to determine the life expectancy of a person who receives a diagnosis of CML in the accelerated phase.

The American Cancer Society indicates a person is less likely to have a long-term response to the treatment.

However, researchers are studying new therapies, which may help prolong the life expectancy of people with a diagnosis of accelerated CML.

The blast phase is the most advanced stage of CML.

People with a blast phase CML diagnosis have at least 20% blast cells in their blood. At this stage, the cancer has also spread beyond the blood into organs or other tissues.

Additionally, a person will likely experience fever, small appetite, and weight loss.

Treatment options

Treatment will vary between people depending on the cancer and the type of treatment a person has already undergone.

A cure for CML in the blast phase is unlikely. That is why doctors will possibly recommend medication and therapy to help a person feel better and relieve their symptoms.

According to the American Cancer Society, a doctor may recommend newer TKIs, such as bosutinib, dasatinib, or nilotinib. Chemotherapy drugs may be effective.

If treatment is successful, a doctor may recommend a stem cell transplant.

Results and success from treatment

With newer therapies, the exact survival rate of people with a blast phase CML diagnosis is not clear.

People with blast phase CML are less likely to respond well to treatment and to recover from their condition than people with a chronic phase CML.

A 2018 study reports that people with CML whose cancer cells have the T315I mutation are less likely to respond to both older and newer TKIs.

As a result, doctors will likely recommend a different strategy, such as:

• a new TKI
• ponatinib, which is the only TKI studies have shown works with the T315I mutation
• chemotherapy

CML is a type of cancer. There are several potential therapies a doctor may recommend a person undergo to treat the cancer, slow its growth, or improve a person’s quality of life.

Below, we describe some of the most common approaches.

Targeted therapies

Targeted therapies are medications that identify and attack cancer cells based on certain markers.

CML contains BCR-ABL, a gene that is not present in healthy cells. The gene causes the production of BCR-ABL protein, which is a type of tyrosine kinase. Targeted therapies for CML contain TKIs that stop the growth and reproduction of cancer cells with the protein.

According to the American Cancer Society, TKIs are a frequently used treatment option in the chronic phase of CML. However, doctors may also use them in later phases of the condition.

Interferon therapy

Interferon therapy is the most common treatment for CML.

It recreates interferons, a substance the immune system produces naturally. The therapy helps prevent the growth and division of cancer cells.

Chemotherapy

Chemotherapy, or chemo, which doctors use to treat many different types of cancer, slows or stops the growth and division of cancer cells.

It may cure the cancer, reduce the likelihood of it returning, or slow or stop its growth. It may also improve symptoms.

Chemotherapy used to be the primary treatment for CML. However, TKIs are now the first line of treatment.

Doctors will typically only recommend chemotherapy if a person does not respond well to TKIs or is undergoing a stem cell transplant.

Radiation therapy

Radiation therapy uses high doses of waves of energy to destroy cancer cells. The damaged cancer cells can no longer reproduce, and die as a result.

The National Cancer Institute states that it can take several weeks of treatment to damage cancer cells enough for them to start dying off. It could then take a few weeks or months for the cells to die off completely.

However, according to the American Cancer Society, radiation is not a common treatment for CML.

Doctors may use it to reduce the size of the spleen if the cancer has spread there, to treat bone pain resulting from bone damage. They may also use it during stem cell transplant throughout the body.

Surgery

Surgery is not a typical treatment option for CML. That is because the cancer can spread throughout a person’s bone marrow and other organs.

Doctors will typically only recommend surgery to remove the spleen if the cancer has affected it.

Stem cell transplant

A stem cell transplant involves destroying cancer cells and some healthy cells in the bone marrow, where the leukemia starts.

Once the cancer is destroyed, a doctor replaces the cells with healthy bone marrow cells that a donor provided. Usually, doctors offer this treatment option to younger people who have a matched tissue donor.

While this is the only treatment that can cure CML, it has several associated risks, including infection and graft-versus-host disease.

A person with a diagnosed CML may wish to try alternative or complementary therapies to help alleviate symptoms. They should seek guidance from a doctor to find the most suitable therapies.

According to a 2016 study, traditional Chinese herbal medicine may be effective in managing CML when people use it in conjunction with Gleevec.

However, a person should speak with their doctor about this type of treatment before finding a licensed practitioner of traditional Chinese medicine.

Another study looked at several different herbs and fruits for the treatment of leukemia. Although the study indicates more research is necessary, it reports positive results when using herbs such as ginger, garlic, and carrots.

CML is a slow-growing type of leukemia that develops in the bone marrow.

Experts distinguish three phases of the condition: chronic, accelerated, and blast. Treatments across the three phases are often similar and involve using TKIs.

A person can work with their doctor to create the best treatment options for them. If the treatment is ineffective, a doctor may recommend other therapies to achieve remission or improve a person’s quality of life.