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Treatments for Chronic Myelogenous Leukemia

Chronic myeloid leukemia (CML), also referred to as chronic granulocytic leukemia or chronic myelogenous leukemia, is a relatively rare form of bone marrow cancer. While it can potentially impact individuals of any age, it is most frequently diagnosed in middle-aged men, affecting a specific category of white blood cells known as myeloid cells. The excess production of immature myeloid cells, known as blasts, disrupts the bone marrow’s ability to generate various types of healthy blood cells.

Factors that Affect Treatment and Prognosis of CML

There are several treatment options you should be aware of when meeting with your healthcare provider for battling chronic myeloid leukemia. It’s important to ensure that your healthcare team is multidisciplinary, meaning that it not only comprises your primary care physician, but also a hematologist, physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, financial counselors and others.

“Standard of care” refers to the best treatments known for remedying CML, and you may be offered, or even encouraged, to participate in clinical trials. Clinical trials are research studies that analyze a new approach for treating cancers, entailing new drugs or a combination of treatments.

CML Treatment Options


Chemotherapy is considered standard of care for treating CML and involves the use of anti-cancer drugs that are injected intravenously or taken by mouth. The drugs employ conventional cytotoxics (cell-killing) whose main goal is to kill cancer cells that are growing and dividing uncontrollably. The drugs begin to flow in the bloodstream, reaching all over the body making this a great option if the cancer has spread throughout the body.

Targeted Therapy

Nearly 90% of all CML patients are affected with the Philadelphia chromosome (Ph). Upon diagnosis, a unique genetic event occurred in your cells in which chromosome 9 and chromosome 22 experienced what is called reciprocal translocation, where a portion of each chromosome switched places, creating a longer chromosome 9 and shorter chromosome 22, resulting in the Philadelphia chromosome.

Chromosome Ph creates a new gene called BCR-ABL, which encodes a protein known as tyrosine kinase, the protein responsible for the uncontrolled growth of white blood cells.

Different from chemotherapy or radiation therapy, targeted or biologic therapies are specific to targeting only the cancer cells while avoiding the healthy cells in the body. This type of treatment requires going through a variety of testing to identify genes, proteins and other factors involved in your leukemia.

These medical evaluations adequately guide your healthcare team to determine the best course of treatment at the appropriate time. The targeted treatment for CML employs a tyrosine kinase inhibitor (TKI), which works to prevent the BCR-ABL from working, thus creating a chain reaction that kills off CML cells.

TKI side effects may cause liver inflammation, which creates an issue for people with hepatitis, therefore a hepatitis test is recommended before starting this treatment. Men and women affected with CML should avoid having children while on TKI targeted therapy as it poses major risks for the unborn child.

Your healthcare team will discuss with you all the side effects that go along with targeted therapy, such as its interaction with certain foods, vitamins or supplements, and they may assign you a dietitian to come up with a comprehensive meal plan of what they recommend to eat and what to avoid. Other side effects, depending on the type of TKI your doctor prescribes, range from fluid build-up, lower blood cell counts, nausea, diarrhea and skin rashes.

Bone Marrow Transplant

A bone marrow transplant involves replacing the leukemia-affected bone marrow with highly specialized hematopoietic stem cells. In contemporary medical practice, this procedure is more accurately described as a stem cell transplantation, as it entails the infusion of stem cells from a healthy bone marrow donor, rather than a direct replacement of the bone marrow itself.

There are two types of stem cell transplantations, allogeneic and autologous. The allogeneic option refers to donated stem cells while the autologous option refers to the patient’s own stem cells. When having a bone marrow or stem cell transplantation, a high dose treatment will dictate the severity of the side effects you may experience. These side effects include increased risk of infection, exhaustion and lack of energy, increased risk of bleeding as well as nausea and diarrhea.

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Radiation therapy utilizes high-energy rays or particles to destroy cancer cells, but is not usually the first treatment option your doctor may recommend for treating your chronic myeloid leukemia. In low doses, it can help in combination with a stem cell transplant. Employing radiation therapy can be very useful if the cancer cells have begun to proliferate in the bone marrow, causing bone pain.

The side effects that may occur depend on what part of the body is being treated with radiation therapy. Skin changes may arise from mild redness to peeling or blistering. Nausea and vomiting may occur if the radiation was administered to the abdomen. Persistent fatigue is the only side effect that occurs regardless of what area was treated.

Treatment by CML Phase

The distinguished team of specialists at Sheba employs state-of-the-art technology to seamlessly integrate and comprehensively assess all diagnostic test results, ensuring swift and precise cancer diagnosis and treatment. Your treatment options depend on the specific type of leukemia you have and the current stage of its progression. These factors will determine your recommended treatment plan by your healthcare team.

Chronic Phase Treatment

As this is a slow moving phase in CML, the goal here would be to mitigate any symptoms you may be experiencing with the end goal being to get rid of cells with the Ph chromosomes to slow down disease progression and avoid it going into the accelerated or blast phase. For this reason, your physician will recommend the TKI targeted therapy. If your physician recommends a bone marrow transplant, they may suggest the allogeneic option if and when TKI therapy doesn’t seem to work.

Accelerated Phase Treatment

In this phase, the CML is beginning to build up in the body relatively quickly and symptoms that were previously a nonissue may arise. This can also contribute to the treatments not responding as the leukemia cells have proliferated to the point in which the genetic mutations are more challenging to curb. Treatment options in this phase depend on how the patient responded to previous treatments. The same drugs that were previously used may be administered again.

Blast Phase Treatment

Targeted therapy may also be administered in combination with chemotherapy, similar to patients being treated for acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL). For those in the blast phase, TKI efficacy may be short-term but can help curb the CML while a bone marrow transplant is being arranged. If and when targeted therapy fails to help, your doctor may recommend you enter a clinical trial.

Follow-up Care

Sheba provides a comprehensive, all-encompassing approach to medical care, ensuring that you and your family do not face these challenging times alone. Confronting cancer, from initial diagnosis to treatment, can be an immensely daunting journey. Seeking assistance may seem like an alarming endeavor, given the emotional burden it can entail. It’s entirely normal to be emotionally affected, and having someone readily available to lend an ear and engage in discussions about your worries is crucial for your wellbeing.

In addition to pharmaceutical interventions, Sheba places significant emphasis on enhancing the patient’s quality of life. Your healthcare team comprises not only oncologists and hematologists, but also a team of social workers, nutritionists and alternative therapy practitioners. Sheba’s dedicated cadre of experts will navigate you through the entire process, keeping you well-informed about available tests, treatments and what to expect.

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Sheba Medical Center provides innovative, personalized medical care to patients from around the world. We are the largest, most comprehensive hospital in the Middle East and dedicated to providing advanced and compassionate medicine for everyone. We welcome all cases, including the rarest and the most challenging. Our medical teams collaborate to provide the best possible health outcomes. From your initial inquiry through the long-term follow-up care, we are here for you.

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