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Types of Treatment for CML

You may have just one type of treatment or a combination of different treatments for chronic myeloid leukemia (CML). Here are some of the types of treatment and their goals for adults who have CML.

Targeted therapy

Gleevec (imatinib), Sprycel (dasatinib), and Tasigna (nilotinib) are drugs called tyrosine kinase inhibitors (TKIs) that specifically target CML cells. They do this by inhibiting the abnormal protein found in CML cells, which is a product of the Philadelphia chromosome. These drugs are most effective in treating early stages of CML. While these drugs are often very effective for long periods of time, they do not cure CML so they must be taken indefinitely. 

Stem cell transplant

This treatment is sometimes used as the first choice for CML, particularly for those younger than age 60, because it offers the best chance for a cure. Other times it is used when other treatments have failed. Before the transplant, you get high doses of chemotherapy (and sometimes radiation therapy) to destroy nearly all your bone marrow. Then stem cells from a healthy donor are used to replace your bone marrow. The cells from the donor may also help eliminate the disease.

Biologic therapy

This type of therapy makes your immune system fight leukemia more effectively. Interferon is the type of biologic therapy used to treat CML. It is used less often now than in the past because of the effectiveness of targeted therapies. 

Chemotherapy

This is not a commonly used treatment for CML. When it is used, the goal is to stop the growth of leukemia cells, putting your disease into remission and keeping it there. Remission is when there is no longer a sign of the disease. The most common chemotherapy used for CML is Hydrea (hydroxyurea). Although it can control the number of leukemia cells, it cannot eliminate the disease. Ara-C (cytarabine) can also be used, and it’s sometimes used with interferon, a biological treatment. Chemotherapy is also used as part of a stem cell transplant.

Radiation therapy

This type of therapy uses high-energy X-rays to kill leukemia cells. It can be used to kill leukemia cells that have spread to your brain or spine. Less commonly used for CML, radiation may be used right before a stem cell transplant. In rare cases, it is used to shrink an enlarged spleen.

Surgery

A splenectomy is surgery to take out your spleen. The spleen is an organ in the abdomen near the stomach that helps filter and store the blood. Your spleen may be removed to improve blood cell counts or to reduce pressure on other organs caused by it being swollen. Surgery is seldom needed today for CML.

What to know about treatment choices for CML

Researchers are always finding new treatment methods for CML. People with CML now have more hope for survival than ever before.

The choices you have for treatment depend on these things:

  • What your lab tests showed

  • Your health

  • Your age

  • Your personal needs or special considerations

  • Phase of the leukemia, which is either chronic, accelerated, or blast

  • Whether you've had a relapse

  • What treatments you've already had

Treatment for cancer can be either local or systemic. Local treatments remove, destroy, or control the cancer cells in one area. When directed at one part of the body, radiation is an example of local treatment. Local treatments are seldom used in CML. Systemic treatments are used to destroy or control cancer cells through the whole body. When taken by mouth or injection, targeted therapy and chemotherapy are examples of systemic treatment. 

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