Chronic Myeloid Leukemia (CML): Treatment Choices

There are many treatment choices for chronic myeloid leukemia (CML). Which one may work best for you? It depends on a number of factors. They include:

• The phase of your CML.
• Results of your tests (the number of blast cells in your blood or bone marrow).
• Your age and overall health.
• What side effects you'll find acceptable.

You may have questions and concerns about your treatment choices. You may also want to know how you'll feel and function after treatment, and if you'll have to change your normal activities.

Your doctor is the best person to answer your questions. They can tell you what your treatment choices are, how well they're expected to work, and what the risks and side effects are. A certain treatment might be advised. Or more than one treatment choice may be offered, and you'll need to decide which one is best for you. It can be hard to make this decision. You may want to consider a second opinion. It may be helpful to involve a close friend or trusted family member.

• Targeted therapy. These are medicines that focus on abnormal proteins on the leukemia (cancer) cells, such as those caused by the Philadelphia chromosome. Targeted therapy works best in treating early stages of CML. They're often the first treatment used. They block an abnormal protein found in CML cells. This therapy can work for a long time. But it doesn't often cure CML. Medicines called tyrosine kinase inhibitors (TKIs) are standard treatment for CML.
• Stem cell transplant. This treatment is mostly used in younger people because it offers the best chance for a cure. It might be a choice if other treatments, such as targeted therapy, are no longer working. Before the transplant, you get high doses of chemotherapy. Sometimes you'll get radiation therapy, too. This is done to destroy almost all of your bone marrow. Then stem cells from a healthy donor are used to replace your bone marrow.
• Immunotherapy. This treatment uses medicines to help your immune system fight leukemia. Interferon is the most common type of immunotherapy used to treat CML. It's not used very often because other, newer treatments work better.
• Chemotherapy (chemo). This treatment uses strong medicines to kill cancer cells. It's not a common treatment for CML. Its goal is to kill the cancer cells and put the cancer into remission. Remission means there are no signs of cancer in the body. The most common chemo medicine used for CML is hydroxyurea. It can control the number of leukemia cells, but it can't cure the disease.
• Radiation therapy. This treatment uses strong X-rays to kill cancer cells. It can be used to kill leukemia cells that have spread to an organ, such as your spleen. It's not a common treatment for CML.
• Surgery. A splenectomy is surgery to take out your spleen. Your spleen may be removed to improve your blood cell counts or to reduce pressure on other organs caused by a swollen spleen. This surgery is not often used for CML.

Researchers are always finding new ways to treat CML. These new methods are tested in clinical trials. Talk with your doctor to find out if there are any clinical trials you might think about.

At first, thinking about treatment choices may seem overwhelming. Talk with your health care team and loved ones. Make a list of questions. Look at the benefits and possible side effects of each choice. Discuss your concerns with your doctor before making a decision.