Treatments for Chronic Myelogenous Leukemia

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.

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.

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.

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.