Treatment for chronic myeloid leukaemia (CML)
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
such as imatinib are usually the first treatment for most people with chronic myeloid leukaemia (CML). But some people might need to have chemotherapy.
You might have chemotherapy:
while you are waiting for test results to confirm your diagnosis - this is to reduce your white blood cell count or to control symptoms
if your CML is in the blast phase
before a
Read more about the phases of CML
Lowering your white blood cell count
You might have a chemotherapy drug called hydroxycarbamide. This aims to reduce your white blood cell count and control any symptoms you might be having. You take hydroxycarbamide as tablets or capsules.
Read about hydroxycarbamide (Hydrea)
Treating blast phase CML
Blast phase CML is where your CML transforms to an . The drugs you have for the blast phase CML depends on the type of leukaemia your CML develops into.
CML most commonly transforms into acute myeloid leukaemia (AML). So the chemotherapy treatment you have is the same chemotherapy treatment as AML.
The second most common transformation is acute lymphoblastic leukaemia (ALL). So if you have this type you have the same chemotherapy treatment as ALL.
There are other types of acute leukaemia and treatments are similar to AML and ALL. Transformation to these types of leukaemia are rarer.
Chemotherapy for AML and ALL is usually a combination of chemotherapy drugs. You usually have these as a drip into your bloodstream. You also take a drug alongside the chemotherapy.
Find out more about the different treatments for leukaemia
Chemotherapy before a stem cell transplant
Your doctor might suggest high dose chemotherapy treatment followed by a stem cell transplant. You might have this if your CML has not responded to previous treatment with tyrosine kinase inhibitors (TKIs).
You need to:
be reasonably fit to have a stem cell transplant
go into hospital to have high dose chemotherapy through a drip
This treatment is intensive and not suitable for everyone. You have a high risk of picking up an infection afterwards and will need to stay in hospital for a few weeks at least.
Read about having a stem cell transplant for CML
Chemotherapy for leukaemia treatment comes in many different forms. These include tablets or capsules that you take by mouth, or a drip into your bloodstream (intravenous). You might also have it as an injection into the fluid around the and brain.
You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:
central line
PICC line
portacath
Find out more about having chemotherapy into your vein
Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, not more or less.
Talk to your healthcare team before you stop taking a cancer drug, or if you have missed a dose.
If you are sick after taking chemotherapy tablets or capsules, don’t take them again straight away. Talk to your medical team for advice if you miss a dose of a cancer drug or want to stop taking treatment for any reason.
Find out more about taking chemotherapy tablets and capsules
You have intrathecal chemotherapy in the same way you have a lumbar puncture. You lie on your side. Your doctor gives you a small injection to numb an area in your back. They then inject the drug between 2 of your spinal bones into the spinal fluid. It takes from 1 to 5 minutes. Afterwards you need to lie flat for an hour.
Not everyone gets this and it depends on the type of leukaemia your CML has transformed into.
You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test.
Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called dihydropyrimidine dehydrogenase (DPD) in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.
Before starting treatment with capecitabine or fluorouracil you have a blood test to check levels of DPD. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor or nurse will talk to you about this.
You can usually take chemotherapy capsules at home. Your doctor or pharmacist gives you instructions on when and how to take them.
You have treatment that goes into your bloodstream through a drip at the cancer day clinic or as an inpatient on the ward. It can take several hours to have chemotherapy so it’s a good idea to have something to read to help to pass the time. A friend or family member can usually be with you to keep you company.
Watch this video about what happens when you have chemotherapy. It is almost 3 minutes long.
Let your doctors know if you:
take any supplements
have been prescribed anything by alternative or complementary therapy practitioners
It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.
Read about the safety of complementary and alternative therapies
Chemotherapy for CML can cause side effects and these can vary from person to person. It depends on the chemotherapy drugs, the dose you have and if you have them with other cancer drugs. Some of the common side effects include:
an increased risk of infection
breathlessness and looking pale
bruising, bleeding gums or nose bleeds
feeling or being sick
diarrhoea
tiredness and weakness
hair thinning or loss
sore mouth and ulcers
loss of appetite
losing weight
tumour lysis syndrome - this is when there are changes to the levels of substances in your blood due to the breakdown of cancer cells. It usually happens when you first start treatment
Chemotherapy for CML can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.
Last reviewed: 23 Jun 2025
Next review due: 23 Jun 2028
You might have a stem cell transplant to treat CML. You usually have stem cells from another person (a donor). Find out more about having one.
Targeted cancer drugs called tyrosine kinase inhibitors (TKIs) are the main treatment for CML. Find out more about your treatment options, the different treatments and how they monitor treatment is working.
You have regular tests during treatment to look for signs of CML. The test results find out how well the treatment is working. Find out more.
Chronic myeloid leukaemia (CML) is often a slowly developing condition. Treatment can keep it under control for many years. Find out how to cope and what support is available.
Chemotherapy is a standard treatment for some types of cancer. It uses anti cancer drugs to destroy cancer cells.
CML starts in the white blood cells called granulocytes. It often develops slowly and treatment can keep it under control for many years. Find out more.
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