HEALTH CONDITION

Treatment

With modern treatments, it's often possible to control chronic myeloid leukaemia (CML) for many years. In a small number of cases, it may be possible to cure it completely.

Imatinib

A medicine called imatinib is now the main treatment for CML. It's usually given soon after a diagnosis is made to slow the progression of the cancer and stop it reaching an advanced phase.

Imatinib works by reducing the production of abnormal white blood cells. It's taken as a tablet once a day.

The side effects of imatinib are usually mild and should improve with time.

They can include:

  • feeling and being sick
  • swelling in the face and lower legs
  • muscle cramps
  • a rash 
  • diarrhoea

Regular blood tests and occasional tests of your bone marrow will be carried out to check whether the treatment is working. If it does work, it will usually be taken for life.

Nilotinib

If you cannot take imatinib or it does not work for you, a medicine called nilotinib may be recommended instead. It's also sometimes used as the first treatment for CML.

Nilotinib works in a similar way to imatinib and is taken as a capsule twice a day. If blood and bone marrow tests show the treatment is working, it's also usually taken for life.

Common side effects of nilotinib include:

If the side effects become particularly troublesome, temporarily stopping treatment usually helps to bring them under control. Treatment can then be resumed, possibly at a lower dose.

Dasatinib

If you cannot take imatinib or nilotinib, or they do not work for you, a similar medicine called dasatinib may be recommended.

This is taken as a tablet once a day and may be taken for life if blood and bone marrow tests show it's working.

Side effects of dasatinib can include:

  • an increased chance of picking up infections
  • tiredness
  • shortness of breath
  • diarrhoea
  • headaches
  • a rash

Bosutinib

Bosutinib is a similar medication to imatinib, nilotinib and dasatinib. It may be recommended if you cannot take these medications, or you've tried them and they have not helped.

Bosutinib is taken as a tablet once a day and may be taken for life if blood and bone marrow tests show it is working.

Common side effects of bosutinib include:

  • diarrhoea
  • feeling and being sick
  • abdominal pain
  • a high temperature (fever)
  • a rash

For more information, see the National Institute for Health and Care Excellence (NICE) guidelines on bosutinib for previously treated chronic myeloid leukaemia.

Ponatinib

Ponatinib is a similar medication to those mentioned above, but it's only recommended for people with a specific genetic change (mutation) called the T315I mutation.

It's taken as a tablet once a day and is taken for life if blood and bone marrow tests show it's working.

Side effects of ponatinib can include:

  • an increased risk of picking up infections
  • tiredness
  • shortness of breath
  • headaches
  • a rash
  • aching joints

Combination therapy

In some cases, a combination of these medicines may be recommended. For example, a combination of high-dose imatinib, dasatinib and nilotinib may be recommended for people who did not respond to normal-dose imatinib.

Chemotherapy

Chemotherapy may be recommended if you cannot take the medicines above, or if CML has progressed to a more advanced stage. It may also be used while you're awaiting tests results to confirm you have CML.

Chemotherapy involves taking medicine to kill the cancerous cells. Tablets are usually used first because they have fewer and milder side effects than chemotherapy injections.

Side effects can include:

  • tiredness
  • a rash
  • increased vulnerability to infection

If your symptoms persist or get worse, chemotherapy injections may be used. These have more side effects than tablets and they tend to be more severe.

In addition to the side effects mentioned above, side effects of chemotherapy injections can include:

The side effects should pass after your treatment has finished, although there's a risk that infertility could be permanent.

Stem cell or bone marrow transplants

A stem cell or bone marrow transplant is the only potential cure for CML, but it's a very intensive treatment and is not suitable for many people with the condition.

This is where donated cells called stem cells (which produce white blood cells) are transplanted into your body so you start to produce healthy white blood cells.

A stem cell transplant involves:

  • having high-dose chemotherapy and radiotherapy to destroy the cancerous cells in your body
  • removing stem cells from the blood or bone marrow of a donor – this will ideally be someone closely related to you, such as a sibling
  • transplanting the donor stem cells into one of your veins

The high doses of chemotherapy and radiotherapy can put an enormous strain on the body and can cause significant side effects and life-threatening complications.

Transplants are generally only considered in younger people with CML, people in good general health and ideally those with a sibling who can provide a donation, as it's more likely to be successful in these cases.

But in many cases of CML, the potential risks of transplantation far outweigh the potential benefits, particularly now that treatment with imatinib can often keep the condition under control for many years.

Clinical trials

In the UK, a number of clinical trials are under way that aim to find the best way to treat leukaemia. Clinical trials are studies that use new and experimental techniques to see how well they work in treating and possibly curing diseases.

You should be aware there's no guarantee the techniques being studied in the clinical trial will be more effective than current treatments.

Your care team will be able to let you know whether there are any clinical trials available in your area, as well as explaining the benefits and risks involved.


Page last reviewed: Sun Sep 2022 Next review due: Wed Feb 2020

NHS Attribution