Treatment options for chronic myeloid leukaemia (CML)

A team of health professionals decides what treatment options you have. The main treatment for chronic myeloid leukaemia (CML) are targeted cancer drugs. These drugs are called tyrosine kinase inhibitors (TKIs).

The main treatment for CML

Targeted cancer drugs are the main treatment for CML. They can change the way that cells work and help the body control the growth of cancer. There are different types of targeted cancer drugs. The main type for CML is tyrosine kinase inhibitors (TKIs).

Examples of TKI drugs for CML include:

• imatinib

• bosutinib

• dasatinib

• nilotinib

Read about targeted cancer drugs for CML

Other treatments for CML

Chemotherapy and a ​stem cell transplant​ are other possible treatments for CML. It is uncommon to have these as targeted cancer drugs work well at controlling most people's CML.

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in your bloodstream.

The chemotherapy drugs you have 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.

Fludarabine, cytarabine, G-CSF and idarubicin (FLAG-Ida) is an example of chemotherapy drug combination you might have for AML. You might also have a TKI drug alongside the chemotherapy.

Find out more about having FLAG-Ida

You might have chemotherapy if you have more advanced stages of CML or before a stem cell transplant.

Find out more about chemotherapy for CML

Stem cell transplant

Having a transplant means destroying as many leukaemia cells as possible and replacing these with healthy ​stem cells​ .

You first have chemotherapy and other treatments such as radiotherapy. This prepares your body for the healthy stem cells.

After the chemotherapy you have the new stem cells into your bloodstream through a drip. These stem cells make their way to the bone marrow. Here they make the ​blood cells​  you need to recover.

You have a stem cell transplant using stem cells from someone else. This is called a donor transplant. 

Read about stem cell transplants for CML

Treatment by phase

There are 3 phases (stages) of CML:

• chronic phase

• accelerated phase

• blast phase

Chronic phase

Most people are diagnosed in the chronic phase. The main aim of treatment is to control your CML and get you into remission. Remission means there's no sign of active leukaemia in your body. And you don’t have any symptoms. This remission can last for years.

The most common treatment is a type of targeted cancer drug called a tyrosine kinase inhibitor (TKI).

There are several different TKIs. The most common drug for CML is imatinib. But your doctor might suggest a different TKI such as dasatanib, nilotinib or asciminib.

Most people respond well to this treatment. CML can stay under control for many years.

Your doctor might suggest you try a different TKI if:

• tests to look for signs of CML show that your CML hasn’t gone away

• tests detect signs of CML again after a period of time

• you have severe side effects from your current treatment

Occasionally TKI treatment does not work. In this situation your doctor might offer you chemotherapy and a stem cell transplant. 

Accelerated and blast phase

You might:

• progress to the accelerated or blast phase after having treatment for chronic phase CML

• be diagnosed in the accelerated or blast phase, although this is less common

Treatment for the accelerated or blast phase depends on whether you have already had treatment. And if so, what treatment you had.

Accelerated phase

Treatment aims to get you back into remission.

The first choice of medicine depends on several factors including if you have already had a TKI medicine.

There are several available including:

• nilotinib 

• dasatinib 

• bosutinib 

• ponatinib

Your doctor might recommend a stem cell transplant if the TKI treatment doesn’t work. This is more likely if you:

• have progressed to accelerated phase from chronic phase

• are younger and fairly fit and well 

Blast phase

Blast phase CML is where your CML transforms to an ​acute leukaemia​ . 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 treatment you have is the same treatment as AML.

The second most common transformation is acute lymphoblastic leukaemia (ALL). So if you have this type you have the same 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.

Your doctor might suggest:

• a combination of chemotherapy drugs such as FLAG-Ida. You have this on its own, or together with a TKI

• a TKI on its own

Your doctor usually recommends you have a stem cell transplant if you are well enough and have a stem cell donor.

You might have also treatment to relieve symptoms.

First and second line treatments

You might hear your doctor refer to your treatment as first line or second line.

First line treatment

This is the first treatment you have when you are diagnosed with CML. The most common first line treatment for CML is a TKI drug.

Second and third line treatments

Some people have to change on to a different treatment. The second treatment you have is called second line treatment. And then the next treatment is called third line treatment, and so on.

The aim of second line treatment is to put your CML back into remission. Remission means there are no signs of CML in your blood.

Supportive treatments

You might have symptoms or problems caused by the leukaemia. Supportive treatments can help to either prevent or control these problems.  

Some of the supportive treatments for CML include:

• a chemotherapy drug called hydroxycarbamide. This is to lower your white blood cell or platelet levels. You might have this whilst you wait for your diagnosis

• fluids through a drip into your vein. This is to prevent complications caused from a condition called ​tumour lysis syndrome​

• medicines to protect your kidneys from tumour lysis syndrome

• antibiotics, antifungals and antivirals to help prevent or treat infections

• ​blood transfusions​  

• ​platelet transfusions​

Read more about the supportive treatments for CML

Monitoring your response to treatment

To begin with, you need to see your doctor regularly, maybe weekly or monthly. You usually have a blood test at each visit. Your doctor might examine you and asks you how you are.  This is to see whether you have any problems with the treatment.

The time between check ups will gradually get longer if everything is going well.

The aim of treatment is to put your CML into remission. There are different tests that look for signs of CML. The test results provide information about how well the treatment is working to control your leukaemia. To monitor your response to treatment, you have blood tests every 3 to 6 months depending on your situation. You might also have bone marrow tests.

Read about monitoring treatment response

Having a break in treatment

Doctors know that it is safe for some people to stop treatment if their CML is under control. This is called a treatment break. Or your doctor might call it treatment free remission.

Your doctor can talk with you about whether a treatment break might be an option for you.

Read about having a treatment break