Materiały źródłowe

• #1 Overview of the treatment of chronic myeloid leukemia – UpToDate

  https://www.uptodate.com/contents/overview-of-the-treatment-of-chronic-myeloid-leukemia

  Overview of the treatment of chronic myeloid leukemia […] CML is associated with the Philadelphia chromosome, t(9;22)(q34;q11), which creates a BCR::ABL1 fusion gene. This genetic abnormality encodes the constitutively active tyrosine kinase BCR::ABL1, which is essential to the development of CML and is the primary target for treatment of CML. […] TREATMENTS: Tyrosine kinase inhibitors (TKI), Other agents, Hematopoietic cell transplantation. […] Treatment of chronic phase chronic myeloid leukemia after failure of the initial tyrosine kinase inhibitor.

• #2 Chronic myelogenous leukemia – Wikipedia

  https://en.wikipedia.org/wiki/Chronic_myelogenous_leukemia

  CML is largely treated with targeted drugs called tyrosine-kinase inhibitors (TKIs) which have led to dramatically improved long-term survival rates since 2001. […] The only curative treatment for CML is a bone marrow transplant or an allogeneic stem cell transplant. Other than this there are four major mainstays of treatment in CML: treatment with tyrosine kinase inhibitors, myelosuppressive or leukapheresis therapy (to counteract the leukocytosis during early treatment), splenectomy and interferon alfa-2b treatment. […] In the past, antimetabolites (e.g., cytarabine, hydroxyurea), alkylating agents, interferon alfa 2b, and steroids were used as treatments of CML in the chronic phase, but since the 2000s have been replaced by Bcr-Abl tyrosine-kinase inhibitors drugs that specifically target BCR-ABL, the constitutively activated tyrosine kinase fusion protein caused by the Philadelphia chromosome translocation.

• #3 Chronic Myeloid Leukemia (CML) | Learn What Is CML | LLS

  https://www.lls.org/leukemia/chronic-myeloid-leukemia

  Chronic myeloid leukemia (CML) is also called chronic myelogenous leukemia, chronic granulocytic leukemia and chronic myelocytic leukemia. CML is one of four main types of leukemia. […] Most CML patients are treated with daily oral drug therapy. […] Since the introduction of tyrosine kinase inhibitor (TKI) therapy in 2001, CML has been transformed from a life-threatening disease to a manageable chronic condition for most patients. People are living longer with CML and experiencing fewer treatment side effects.

• #4 Chronic Myeloid Leukemia (CML): Symptoms, Treatment & Prognosis

  https://my.clevelandclinic.org/health/diseases/21845-chronic-myelogenous-leukemia-cml

  Chronic myeloid (myelogenous) leukemia (CML) is blood cancer that starts in the blood-forming myeloid cells or stem cells in your bone marrow. Healthcare providers treat CML with innovative therapies that have turned CML from being a potentially life-threatening illness into a chronic illness. […] Many people with CML may have normal life spans, thanks to therapy that has turned the condition from a life-threatening illness into a chronic illness that medication can manage. […] Prompt treatment keeps CML from getting worse. Without treatment, chronic myeloid leukemia can become a life-threatening illness within three to four years. […] Healthcare providers typically treat chronic phase CML with tyrosine kinase inhibitors (TKIs). TKIs are a type of targeted therapy. In CML, the targets are the abnormal BCR-ABL enzymes that let abnormal white blood cells divide and multiply uncontrollably. TKIs block the enzymes so that CML cells start to die.

• #5 Targeted Therapy Drugs for Chronic Myeloid Leukemia | American Cancer Society

  https://www.cancer.org/cancer/types/chronic-myeloid-leukemia/treating/targeted-therapies.html

  Chronic myeloid leukemia (CML) cells contain an abnormal gene, BCR-ABL, that isn’t found in normal cells. This gene makes a protein, BCR-ABL, which causes CML cells to grow and reproduce out of control. BCR-ABL is a type of protein known as a tyrosine kinase. […] Drugs known as tyrosine kinase inhibitors (TKIs) that target BCR-ABL are the most common treatment for CML. […] TKIs that can be used to treat CML include: Imatinib (Gleevec), Dasatinib (Sprycel), Nilotinib (Tasigna), Bosutinib (Bosulif), Ponatinib (Iclusig), Asciminib (Scemblix). […] These drugs seem to work best when CML is in the chronic phase, but some can also help people with more advanced disease (accelerated or blast phases). […] In most people, the TKIs don’t seem to make the leukemia go away forever, so these drugs need to be taken indefinitely.

• #6 Chronic Myelogenous Leukemia – CML | Hematology-Oncology Associates of CNY

  https://www.hoacny.com/patient-resources/types-cancer/chronic-myelogenous-leukemia-%E2%80%93-cml

  Chronic myeloid leukemia (also called CML or chronic myelogenous leukemia) is a slowly progressing blood and bone marrow disease that usually occurs during or after middle age and rarely occurs in children. […] There are different types of treatment for patients with chronic myeloid leukemia. […] The following types of treatment are used: Targeted therapy, Chemotherapy, Immunotherapy, High-dose chemotherapy with stem cell transplant (SCT), Donor lymphocyte infusion (DLI), Surgery. […] Treatment of chronic phase chronic myeloid leukemia may include: targeted therapy (asciminib, imatinib mesylate, nilotinib, dasatinib, bosutinib), allogeneic bone marrow transplant or stem cell transplant. […] Treatment of accelerated phase chronic myeloid leukemia may include: targeted therapy (bosutinib), targeted therapy (imatinib mesylate) followed by allogeneic stem cell transplant.

• #7 Treating Chronic Myeloid Leukemia | American Cancer Society

  https://www.cancer.org/cancer/types/chronic-myeloid-leukemia/treating.html

  If youve been diagnosed with chronic myeloid leukemia (CML), your treatment team will discuss your options with you. Its important to weigh the benefits of each treatment option against the possible risks and side effects. […] Targeted therapy drugs are the main treatment for chronic myeloid leukemia (CML), but some patients might also need other treatments. […] Treatment options for people with chronic myeloid leukemia (CML) depend on the phase of their disease (chronic, accelerated, or blast phase), their age, other prognostic factors, and the availability of a stem cell donor with matching tissue type. […] Its important to discuss all treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs. […] Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the-art cancer treatment.

• #8 Chronic Myeloid Leukemia (CML) | Treatment by Phase of CML | LLS

  https://www.lls.org/leukemia/chronic-myeloid-leukemia/treatment

  It’s important that your doctor is experienced in treating patients with chronic myeloid leukemia (CML) or has access to a CML specialist. Doctors who specialize in treating patients with CML are called hematologist-oncologists. […] Tyrosine kinase inhibitor (TKI) therapy is standard treatment for chronic phase CML. TKIs are often successful at managing CML for long periods of time. The following TKIs are approved as primary treatment for chronic phase CML: Imatinib (Gleevec), Dasatinib (Sprycel), Nilotinib (Tasigna), Bosutinib (Bosulif), Asciminib (Scemblix). […] The goal in treating accelerated phase CML, just as with the chronic phase, is to eliminate all cells that contain the BCR::ABL1 gene, leading to a remission. […] The leukemia cells in patients with blast phase CML have become very abnormal. Blast phase CML is similar to acute leukemia, with higher blood cell counts and more severe symptoms.

• #9 Targeted Therapy Drugs for Chronic Myeloid Leukemia | American Cancer Society

  https://www.cancer.org/cancer/types/chronic-myeloid-leukemia/treating/targeted-therapies.html

  It’s also important to understand that all of the TKIs can harm a fetus if taken during pregnancy. […] Imatinib (Gleevec) was the first drug to specifically target the BCR-ABL tyrosine kinase protein, and its sometimes the first drug tried in a person with CML. […] Most people with CML respond to treatment with imatinib, and these responses often last for many years. […] Dasatinib (Sprycel) is another TKI that targets the BCR-ABL protein. […] Nilotinib (Tasigna) is another TKI that targets the BCR-ABL protein. […] Bosutinib (Bosulif) is another TKI that targets the BCR-ABL protein. […] Ponatinib (Iclusig) is a TKI targeting the BCR-ABL protein. […] Asciminib (Scemblix) targets a different part of the BCR-ABL protein than the other TKIs. […] This drug can be used as the first treatment for chronic phase CML, or it can be used if other TKIs have already been tried or if the leukemia cells have a gene change called the T315I mutation.

• #10 Treatment for Chronic Myeloid Leukemia (CML) | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/leukemias/treatment/chronic-myeloid-leukemia

  Hematologic oncologist Ellin Berman leads clinical trials of new medical approaches to treating CML. Advances in the treatment of chronic myeloid leukemia are giving new hope to patients. Our doctors base their treatment approach on a number of factors, including the number of blasts in the bone marrow, any chromosomal abnormalities, and your overall health. […] Three drugs are now available for treating CML in its chronic phase: imatinib (Gleevec), dasatinib (Sprycel), nilotinib (Tasigna). Our researchers were instrumental in the development of all three, which work by blocking the activity of BCR/ABL, the abnormal protein found in CML. Although none of these drugs is a cure, they can dramatically improve the lives of people with the disease and, in most cases, help to manage it for years. Your doctor may recommend imatinib as initial therapy for CML. Imatinib was the first drug discovered to be capable of controlling CML, and a very high percentage of patients in the chronic phase of the disease respond positively to it. Typically, patients complete blood count normalizes within the first three months of treatment, and the number of cells that contain the Philadelphia chromosome decreases.

• #11 Chronic Myelogenous Leukemia (CML) Treatment Protocols: Treatment Protocols

  https://emedicine.medscape.com/article/2005453-overview

  The second-generation TKIs have shown superior efficacy and higher rates of CCyR and MMR when compared with imatinib. Lower rates of transformation to advanced phase were also seen. […] In patients who receive first-line therapy with TKIs, the rate of decline in BCR-ABL1 transcripts correlates with long-term response. […] For CP-CML, determination of the patient’s Sokal or Hasford risk score is recommended prior to initiation of TKIs. […] For low-risk patients, any of the following may be used for first-line treatment: Imatinib, 400 mg PO daily; Nilotinib, 300 mg PO twice a day (Tasigna) or 142 mg twice a day (Danziten); Dasatinib, 100 mg PO daily; Bosutinib 400 mg PO once daily. […] For intermediate- or high-risk patients, bosutinib, dasatinib or nilotinib is preferred over imatinib; dosages are the same as for low-risk patients.

• #12 Treatment options for chronic myeloid leukaemia (CML) | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/chronic-myeloid-leukaemia-cml/treatment/treatment-decisions

  A team of health professionals decides what treatment options you have. The most common treatments for chronic myeloid leukaemia (CML) are targeted cancer drugs. These drugs are called tyrosine kinase inhibitors (TKIs). […] The main treatment for CML are targeted cancer drugs. Other possible treatments include chemotherapy and a stem cell transplant. […] Targeted cancer drugs can change the way that cells work and help the body control the growth of cancer. There are different types of targeted cancer drugs. The main type for CML are: tyrosine kinase inhibitors (TKIs). […] Examples of TKI drugs for CML are imatinib, bosutinib, dasatinib and nilotinib. […] Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in your bloodstream.

• #13 Chronic Myelogenous Leukemia (CML): Causes, Symptoms, Treatment

  https://www.webmd.com/cancer/lymphoma/cml-need-to-know-first

  The goal of your treatment is to destroy the leukemia blood cells in your body and restore healthy ones to a normal level. It’s usually not possible to get rid of all the bad cells. […] If you get treatment during the early, chronic phase of CML, it can help prevent the disease from moving to a more serious level. […] Doctors usually give drugs known as tyrosine kinase inhibitors (TKIs) first. They slow down the rate at which your body makes leukemia cells. […] Some TKIs that are commonly used include: Bosutinib (Bosulif), Dasatinib (Sprycel), Imatinib (Gleevec), Nilotinib (Tasigna). […] You may get bosutinib (Bosulif) and ponatinib (Iclusig) if other drugs don’t help or make you too sick. […] If your disease continues to get worse after you’ve used two or more TKIs, your doctor may suggest either asciminib (Scemblix) or omacetaxine mepesuccinate (Synribo).

• #14 Chronic Myelogenous Leukemia (CML) Treatment Protocols: Treatment Protocols

  https://emedicine.medscape.com/article/2005453-overview

  Bosutinib (Bosulif), a second-generation TKI, is a dual Src and ABL kinase inhibitor. It is approved for chronic-, accelerated-, or blast-phase Ph+ CML in patients resistant to or intolerant of other therapies, including imatinib, dasatinib, or nilotinib, but is not for use in cases with the T315I mutation. […] TKI doses recommended for AP-CML and BP-CML are as follows: Imatinib 300 mg twice a day or 600 mg once daily; Nilotinib 400 mg twice a day (Tasigna) or 190 mg twice a day (Danziten); Dasatinib 140 mg daily; Ponatinib 45 mg once daily. […] Several studies have demonstrated that discontinuation of TKI therapy is feasible in very carefully selected patients, after the desired response has been achieved and BCR-ABL1 transcripts have become clinically undetectable.

• #15 Chronic Myelogenous Leukemia (CML) Treatment Protocols: Treatment Protocols

  https://emedicine.medscape.com/article/2005453-overview

  For the rare patient who is intolerant to those TIKIs, consider one of the following: Bosutinib 400 mg PO once daily or Ponatinib 45 mg PO once daily. […] For patients with intolerance to all TKIs, the following options can be alternatives: Pegylated (PEG)-interferon alfa-2a 450 mcg SC weekly or PEG-interferon alfa-2b 6 mcg/kg SC weekly or Hematopoietic stem cell transplantation. […] Response to TKI is monitored. If desired milestones are not achieved, evaluation for patient compliance, consideration of a new drug interaction, and mutation analysis are recommended. […] Omacetaxine (Synribo) is a protein translation inhibitor that is indicated for chronic- or accelerated-phase CML with resistance and/or intolerance to two or more TKIs (eg, dasatinib, nilotinib, imatinib). […] Ponatinib (Iclusig), a panBCR-ABL TKI, is approved for patients with any phase of CML (chronic, accelerated, blast) with the T315I mutation.

• #16 Chronic Myeloid Leukemia Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/leukemia/hp/cml-treatment-pdq

  Treatment of patients with chronic myeloid leukemia (CML) is usually initiated at diagnosis, which is based on the presence of an elevated white blood cell count, splenomegaly, thrombocytosis, and identification of the BCR::ABL1 translocation. […] The optimal front-line treatment for patients with chronic-phase CML involves specific inhibitors of the BCR::ABL1 tyrosine kinase. […] Allogeneic BMT or SCT has also been used with curative intent. […] Long-term data are also available for patients treated with interferon alfa. […] Hydroxyurea is superior to busulfan in the chronic phase of CML, with significantly longer median survival and significantly fewer severe adverse effects. […] Treatment options for chronic-phase chronic myeloid leukemia (CML) include: Targeted therapy with an allosteric inhibitor of BCR::ABL1 at the ABL1 myristoyl pocket (asciminib), Targeted therapy with other BCR::ABL1 tyrosine kinase inhibitors (TKIs) (nilotinib, dasatinib, bosutinib, or imatinib), Allogeneic bone marrow transplant (BMT) or stem cell transplant (SCT).

• #17 Treatment for Chronic Myeloid Leukemia (CML) | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/leukemias/treatment/chronic-myeloid-leukemia

  Although imatinib is effective at controlling CML in most patients, a very small number experience adverse side effects. In addition, over time, some patients become resistant to imatinib when the BCR/ABL protein mutates and imatinib can no longer interact with it. If imatinib is not effective, your doctors may recommend one of two newer drugs called dasatinib or nilotinib. In some cases, your doctor may recommend one of these medications as upfront treatment. There is somewhat less experience with these drugs as compared with imatinib, although two recent studies suggest that compared to imatinib, dasatinib and nilotinib may be more efficient in clearing the bone marrow of leukemia cells, and may work faster. In some instances, your doctor may recommend one drug over the other if you have problems with your lungs or heart. During treatment with any of these three medications, patients are monitored frequently to assess their response and to check for side effects.

• #18 Chronic Myelogenous Leukemia (CML) Treatment & Management: Approach Considerations, Imatinib, Newer Tyrosine Kinase Inhibitors

  https://emedicine.medscape.com/article/199425-treatment

  The protein translation inhibitor omacetaxine (Synribo) is approved for treatment of chronic- or accelerated-phase CML in patients with resistance to and/or intolerance of 2 or more tyrosine kinase inhibitors (TKIs). […] Although a minority of CML patients who have a major molecular response to TKI therapy can discontinue TKIs and maintain treatment-free remission, allogeneic hematopoietic stem cell transplantation (HSCT) remains the only proven cure for CML. […] Splenectomy and splenic irradiation have been used in patients with large and painful spleens, usually in the late phase of CML. […] Molecular monitoring in CML is a powerful tool to document treatment responses and predict relapse. […] Discontinuing TKI therapy for certain patients, an approach first put forward in 2006, has the potential to reduce adverse effects associated with lifelong TKI therapy and to be cost-effective measure.

• #19 Treatment options for chronic myeloid leukaemia (CML) | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/chronic-myeloid-leukaemia-cml/treatment/treatment-decisions

  Supportive treatments can help to either prevent or control these problems. […] There are several other treatments you might have for CML: A chemotherapy drug called hydroxycarbamide. […] Your doctor usually recommends you have a stem cell transplant if you are well enough and have a stem cell donor. […] The aim of treatment is to put your CML into remission. Remission means there are no signs of CML in your blood. The doctors refer to remission as response to treatment. […] Doctors know that it is safe for some people to stop treatment if their CML is under control. This is called a treatment break. Or your doctor might call it treatment free remission. […] Your doctor might ask if youd like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

• #20 Management of chronic myeloid leukemia in 2023 – common ground and common sense | Blood Cancer Journal

  https://www.nature.com/articles/s41408-023-00823-9

  With the improving knowledge of CML and its management, the goals of therapy need to be revisited to ensure an optimal use of the BCR::ABL1 TKIs in the frontline and later-line therapy of CML. […] In the frontline therapy of CML in the chronic phase (CML-CP), imatinib and the three second-generation TKIs (bosutinib, dasatinib and nilotinib) are associated with comparable survival results. […] The choice of the second-generation TKI versus imatinib in frontline therapy is based on the treatment aims (survival, TFR), the CML risk, the drug cost, and the toxicity profile with respect to the patients comorbidities. […] For patients with true resistance to second-generation TKIs or with the T315I gatekeeper mutation, the third-generation TKIs are preferred. […] Ponatinib should be considered first because of the cumulative experience and results in the CML subsets, including in T315I-mutated CML. […] Asciminib is a third-generation TKI with possibly a better toxicity profile, but lesser activity in T315I-mutated CML. […] Olverembatinib is another potent third-generation TKI with early promising results.

• #21 Chronic Myelogenous Leukemia (CML) Treatment & Management: Approach Considerations, Imatinib, Newer Tyrosine Kinase Inhibitors

  https://emedicine.medscape.com/article/199425-treatment

  The goals of treatment of chronic myelogenous leukemia (CML) are threefold and have changed markedly since the advent of tyrosine kinase inhibitor (TKI) therapy. They are as follows: […] The standard treatment of choice for chronic phase CML is a TKI: either the first-generation TKI imatinib, which is a specific small-molecule inhibitor of BCR-ABL in all phases of CML, or a second-generation TKIs nilotinib (Tasigna), dasatinib (Sprycel), or bosutinib (Bosulif). […] In patients with a durable deep molecular response to TKI therapy, treatment discontinuation may be considered. […] Some patients with CML progress to a transitional or accelerated phase, which may last for several months. […] Many of the treatment decisions in CML, including possible hematopoietic stem cell transplantation and investigative options for younger patients, are extremely complex and in constant flux.

• #22 8 Treatment Options for CML | MyLeukemiaTeam

  https://www.myleukemiateam.com/resources/chronic-myeloid-leukemia-treatment-options

  Stem cell transplantation is the treatment that is most likely to cure CML. However, this procedure is risky and can cause serious side effects. Its often only an option for younger people and those without any other health conditions. […] The treatment goal for accelerated-phase CML is usually to kill cancer cells and help a person go into remission, in which leukemia signs and symptoms go away. In some cases, the goal may be to help the leukemia go back to the chronic phase. […] The first treatment that you receive for CML may be called initial therapy or first-line therapy. If the leukemia doesnt respond to initial therapy, the cancer is said to be resistant or refractory. In the case of refractory leukemia, a different treatment or second-line therapy is tried. […] Initial treatment with imatinib is usually effective at treating CML. Most people who use this drug have no remaining signs of cancer cells. However, sometimes the drug stops working over time. In such cases, doctors may recommend increasing the imatinib dose or switching to a different TKI drug. […] Chemotherapy may be used if TKIs dont work, especially for those with chronic- or accelerated-phase CML that doesnt respond to TKIs.

• #23 Chronic myeloid leukaemia (CML) – Leukaemia Foundation

  https://www.leukaemia.org.au/blood-cancer/types-of-blood-cancer/leukaemia/chronic-myeloid-leukaemia/

  Chronic myeloid leukaemia (CML) is a type of cancer that affects the blood and bone marrow. In CML the bone marrow produces too many white cells, called granulocytes. These cells (sometimes called blasts or leukaemic blasts) gradually crowd the bone marrow, interfering with normal blood cell production. They also spill out of the bone marrow and circulate around the body in the bloodstream. Because they are not fully mature, they are unable to work properly to fight infections. Over time, a shortage of red cells and platelets can cause anaemia, bleeding and/or bruising. […] Most people (more than 90%) are diagnosed in the early chronic phase of CML. Blood counts remain relatively stable and the proportion of blast cells in the bone marrow and blood is low (five per cent or less). Most people are generally well at this stage and have few, if any, troubling symptoms of their disease.

• #24 Chronic Myeloid Leukemia | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/c/chronic-myeloid-leukemia

  Chronic myeloid leukemia (CML), also called chronic myelogenous leukemia, is a type of cancer affecting the blood and bone marrow. […] Treatment begins as soon as possible after chronic myeloid leukemia is found. Doctors will treat any associated symptoms, such as fever and infections, anemia, or risk of bleeding. […] Treatment for CML may include medicines called tyrosine kinase inhibitors (TKI). These drugs are taken by mouth every day, and often work very well and have few side effects. […] A drug called hydroxyurea may be used at first, along with TKI therapy, to reduce the number of white blood cells in the bloodstream. After a time, the hydroxyurea is stopped and the TKI therapy continues. TKI therapy clears out CML cells and allows normal cells to fill up the marrow and blood system. Patients can stay on TKI therapy indefinitely but are checked regularly for side effects and to confirm that there are no CML cells remaining.

• #25 Chronic Myeloid Leukemia Treatment (PDQ®) – PDQ Cancer Information Summaries – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK65916/

  Treatment options for chronic-phase chronic myeloid leukemia (CML) include: Targeted therapy with an allosteric inhibitor of BCR::ABL1 at the ABL1 myristoyl pocket (asciminib), Targeted therapy with other BCR::ABL1 tyrosine kinase inhibitors (TKIs) (nilotinib, dasatinib, bosutinib, or imatinib), Allogeneic bone marrow transplant (BMT) or stem cell transplant (SCT). […] The U.S. Food and Drug Administration approved bosutinib as a first-line treatment for patients with accelerated-phase CML. […] Induction of remission using a TKI and consideration of an allogeneic SCT for patients with poor responses, when feasible, is a standard approach for patients with accelerated-phase CML. […] Treatment options for blastic-phase chronic myeloid leukemia (CML) include: Targeted therapy with tyrosine kinase inhibitors (TKIs), Allogeneic bone marrow transplant (BMT) or stem cell transplant (SCT). […] Asciminib is an allosteric inhibitor of BCR::ABL1 at the ABL1 myristoyl pocket, a site unique from those used by TKIs.

• #26 Chronic myeloid leukaemia treatment – Leukaemia Foundation

  https://www.leukaemia.org.au/blood-cancer/types-of-blood-cancer/leukaemia/chronic-myeloid-leukaemia/treatment/

  Chronic myeloid leukaemia treatment […] How is CML treated? The treatment chosen for your CML largely depends on the phase of your disease, your age and general health. Most people with CML will be treated with drugs called tyrosine kinase inhibitors (TKIs). TKIs work by blocking the activity of an enzyme called bcr-abl and thereby preventing the growth and proliferation of the leukaemic cells. The most common decision to be made at diagnosis is which of the available TKI drugs is most suited to you. This varies from person to person and your doctor will examine all the information about you that is available to them to decide on the most suitable option. […] While these drugs are very effective at controlling the disease, most people are required to take these medications for life to keep the disease under control. Only a minority of patients may be ‘cured’ by TKI therapy and are able to safely stop taking them. People with well-controlled CML are expected to have a normal life expectancy. […] In a very small number of patients, a stem cell transplant from a matched donor may be considered. This is only considered in patients who do not respond well to TKI therapy and have progressive CML. This treatment, although offering the prospect of a cure, carries serious risks. […] While you are in the chronic phase of CML, treatment is aimed at controlling your disease, prolonging this phase and delaying the onset of symptoms and complications for as long as possible. When you are first diagnosed with CML it can take one to two weeks to start therapy with a TKI. […] Adherence, also commonly called compliance, to treatment with TKIs for CML is very important for the drugs to work effectively. If there is not enough drug in the body (due to skipped doses), it is possible that the CML cells may become resistant via a process called mutation. Some mutations do not respond well to TKIs, therefore it is very important to take your medication as directed and do not make any changes without discussing it first with your haematologist. […] Although uncommon, some people already have advanced disease at diagnosis, while others may experience disease progression. Advanced phase treatment is aimed at re-establishing the chronic phase of CML and reducing any troublesome symptoms. There are several treatment options that may be used. The treatment of accelerated and blast phase CML usually involves a more intensive approach. These include more intensive chemotherapy using a combination of drugs similar to those used to treat acute leukaemia in combination with a different TKI. […] A stem cell transplant is now generally only used for people in whom the CML has not responded to TKIs, or who were diagnosed in the accelerated phase. Some patients may benefit by participating in a clinical trial.

• #27 Chronic Myelogenous Leukemia – CML | Hematology-Oncology Associates of CNY

  https://www.hoacny.com/patient-resources/types-cancer/chronic-myelogenous-leukemia-%E2%80%93-cml

  Treatment of blastic phase chronic myeloid leukemia may include: targeted therapy (imatinib mesylate, dasatinib, nilotinib, bosutinib), allogeneic bone marrow transplant or stem cell transplant, chemotherapy as palliative therapy to relieve symptoms and improve quality of life. […] In relapsed chronic myeloid leukemia (CML), the number of blast cells increases after a remission. Treatment of relapsed CML may include targeted therapy (ponatinib or asciminib).

• #28 Chronic Myeloid Leukemia Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/leukemia/hp/cml-treatment-pdq

  Treatment options for accelerated-phase chronic myeloid leukemia (CML) include: Targeted therapy with tyrosine kinase inhibitors (TKIs), Allogeneic stem cell transplant (SCT). […] Treatment options for blastic-phase chronic myeloid leukemia (CML) include: Targeted therapy with tyrosine kinase inhibitors (TKIs), Allogeneic bone marrow transplant (BMT) or stem cell transplant (SCT). […] Treatment options for relapsed chronic myeloid leukemia (CML) include: Targeted therapies with tyrosine kinase inhibitors (TKIs) such as Ponatinib and Asciminib.

• #29 Treatment for Chronic Myeloid Leukemia (CML) | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/leukemias/treatment/chronic-myeloid-leukemia

  If your disease is in the accelerated phase, treatment may include the options outlined above imatinib, dasatinib, nilotinib, and bone marrow transplantation. If you have CML that does not respond positively to imatinib, dasatinib, or nilotinib, your doctor may also suggest a drug called interferon (a type of immunotherapy) or chemotherapy. Patients may also receive transfusions of blood or blood products to relieve symptoms. […] If your disease is in the blast phase, treatment is likely to include chemotherapy in addition to imatinib, dasatinib, or nilotinib. This is a difficult phase of the disease to treat. Often, stem cell transplantation is recommended if an appropriate donor is available and you are healthy enough to undergo the procedure. Because the best results with stem cell transplantation occur when CML is in the chronic or early accelerated phase, the goal of treatment during the blast phase is to first get the patient back to an earlier phase of the disease before transplantation takes place.

• #30 Chronic Myeloid Leukemia (CML) – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/leukemias/chronic-myeloid-leukemia-cml

  Tyrosine kinase inhibitors inhibit the BCR-ABL oncogene, which is responsible for induction of CML. These drugs are dramatically effective in achieving complete hematologic and cytogenetic remissions of Ph chromosome positive CML (Ph+ CML) and are clearly superior to other drug regimens (eg, interferon with or without cytarabine). […] The response to TKI therapy is the most important prognostic factor for patients with CML. […] Rarely, other drugs are used as palliation in CML. These drugs include hydroxyurea, busulfan, and recombinant interferon or pegylated interferon. […] Allogeneic stem cell transplantation, because of its toxicity and because of the efficacy of tyrosine kinase inhibitors, is used selectively. Transplantation is reserved for patients with accelerated- or blast-phase CML resistant to BCR-ABL inhibitors. Transplantation can be curative. […] Tyrosine kinase inhibitors are extremely effective, prolong survival, and may even be curative. […] Stem cell transplantation can be curative and may help patients who do not respond to tyrosine kinase inhibitors or who progress to accelerated or blast phase.

• #31 Stem Cell Transplantation for Chronic Myelogenous Leukemia | NYU Langone Health

  https://nyulangone.org/conditions/chronic-myelogenous-leukemia/treatments/stem-cell-transplantation-for-chronic-myelogenous-leukemia

  Stem Cell Transplantation for Chronic Myelogenous Leukemia […] If a person has a more advanced form of chronic myelogenous leukemia (CML) that has not gone into remission after treatment with targeted chemotherapy drugs, an NYU Langone hematologistoncologist may recommend a stem cell transplant. Also known as a bone marrow transplant, the procedure is usually an option for people up to age 75 who are otherwise healthy. […] A stem cell transplant is the only treatment that can cure CML, but it does have risks and serious side effects. In stem cell transplantation, a doctor delivers a high-dose chemotherapy drug through a vein with intravenous (IV) infusion for a period of days. This intense treatment destroys cancerous stem cells, which are immature blood cells located in the bone marrow.

• #32 Stem Cell Transplantation for Chronic Myelogenous Leukemia | NYU Langone Health

  https://nyulangone.org/conditions/chronic-myelogenous-leukemia/treatments/stem-cell-transplantation-for-chronic-myelogenous-leukemia

  Because they also destroy normal stem cells, these cells are then replaced with healthy stem cells provided by a donor. This is called an allogeneic stem cell transplantation. The team at the Blood and Marrow Transplantation and Cellular Therapy Center, part of NYU Langones Perlmutter Cancer Center, specializes in stem cell transplantations to treat CML. This procedure is performed at the Rita J. and Stanley H. Kaplan Blood and Marrow Transplant and Cell Therapy Center. […] An allogeneic stem cell transplant requires a donation of stem cells from a healthy person who is considered a match. This means the persons genetic makeup and tissue types are compatible with yours. Siblings are usually ideal matches. […] After your doctor determines that donor cells are a good match, he or she collects stem cells from the donor. In a peripheral blood stem cell harvest, the doctor collects blood from the donor through a catheter, or hollow tube, thats inserted into a vein in the arm. The stem cells are either infused into your body that day or frozen and stored for future use. The donor can go home the same day.

• #33 Chronic myeloid leukemia | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/chronic-myeloid-leukemia

  Tyrosine kinase inhibitors (TKIs) are drugs used for targeted therapy. They block the protein produced by the BCR-ABL gene that makes white blood cells multiply uncontrollably. These drugs include imatinib (Gleevec), dasatinib (Sprycel) and nilotinib (Tasigna). They’re taken orally. […] Targeted therapy is effective in 80% of CML patients. In successful cases, the Philadelphia chromosome disappears and normal blood counts are restored. For most patients, TKIs prevent CML from progressing to the accelerated or blast phase. […] Another highly effective option for treating CML is a stem cell or bone marrow transplant (BMT). Typically, the transplant uses stem cells collected from a matched donor, a process called allogeneic transplant. This is a risky procedure, with a treatment-related death rate of 15 to 20%, so it’s only for patients who don’t respond to TKIs.

• #34 Chronic Myeloid Leukemia (CML): Treatment Choices

  https://healthlibrary.brighamandwomens.org/Conditions/Cancer/Specific/LeukemiaCML/34,BCMLT2

  Stem cell transplant. This treatment is sometimes used for CML. But it’s 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. And sometimes you’ll get radiation therapy, too. This is done to destroy almost all 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.

• #35 Chronic Myelogenous Leukemia | CML | MedlinePlus

  https://medlineplus.gov/chronicmyeloidleukemia.html

  High-dose chemotherapy with stem cell transplant […] Donor lymphocyte infusion (DLI). DLI is a treatment that may be used after a stem cell transplant. It involves giving you an infusion (into your bloodstream) of healthy lymphocytes from the stem cell transplant donor. Lymphocytes are a type of white blood cell. These donor lymphocytes may kill the remaining cancer cells. […] Surgery to remove the spleen (splenectomy). […] Which treatments you get will depend on which phase you are in, your age, your overall health, and other factors. When the signs and symptoms of CML are reduced or have disappeared, it is called remission. The CML may come back after remission, and you may need more treatment.

• #36 Treatment for Chronic Myeloid Leukemia (CML) | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/leukemias/treatment/chronic-myeloid-leukemia

  Researchers are studying the most-effective ways to use the targeted therapies that are now available (imatinib, dasatinib, and nilotinib). This includes determining the best timing and dosage. We are also working to create and test additional therapies that will block variants of the mutated BCR/ABL gene. […] After a stem cell transplantation for CML, some patients experience a recurrence of the disease. A strategy developed here at MSK and at other institutions a reinfusion of a particular type of white blood cell called lymphocytes from the original stem cell donor may boost these patients ability to fight the disease. The effectiveness of this approach is now under study.

• #37 Chemotherapy treatment for chronic myeloid leukaemia (CML) | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/chronic-myeloid-leukaemia-cml/treatment/chemotherapy-cml

  Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream. […] Targeted cancer drugs such as imatinib are usually the first treatment for most people with chronic myeloid leukaemia (CML). But some people might need to have chemotherapy. […] You might have a chemotherapy drug called hydroxycarbamide. This aims to reduce your white blood cell count and control any symptoms you might be having. You take hydroxycarbamide as capsules. […] The drugs you have for the blast phase of CML are the same as for acute myeloid leukaemia (AML). You usually have a combination of chemotherapy drugs into your bloodstream through a drip. You might take a tyrosine kinase inhibitor (TKI) drug alongside the chemotherapy. […] Your doctor might suggest high dose chemotherapy treatment followed by a stem cell or bone marrow transplant. You might have this if your CML has not responded to previous treatment with tyrosine kinase inhibitors (TKIs).

• #38 Treatment options for chronic myeloid leukaemia (CML) | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/chronic-myeloid-leukaemia-cml/treatment/treatment-decisions

  Fludarabine, idarubicin and cytarabine are examples of chemotherapy drugs for CML. […] You usually only have chemotherapy if you have more advanced stages of CML. […] You have a stem cell transplant after very high doses of chemotherapy. The chemotherapy kills the cancer cells and also the stem cells in your bone marrow. […] The most common treatment is a type of targeted cancer drug called a tyrosine kinase inhibitor (TKI). […] Most people respond well to this treatment. CML can stay under control for many years. […] Occasionally TKI treatment does not work. In this situation your doctor might offer you chemotherapy and a stem cell transplant. […] Treatment aims to get you back into remission. […] The aim of second line treatment is to put your CML back into remission. Remission means there are no signs of CML in your blood.

• #39 Chemotherapy treatment for chronic myeloid leukaemia (CML) | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/chronic-myeloid-leukaemia-cml/treatment/chemotherapy-cml

  You might take chemotherapy as capsules, or have it directly into your bloodstream (intravenously). […] You need to have blood tests to make sure its safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment. […] You can usually take chemotherapy capsules at home. Your doctor or pharmacist gives you instructions on when and how to take them. […] Let your doctors know if you take any supplements. […] Its unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful. […] Common chemotherapy side effects include feeling sick, loss of appetite, losing weight, feeling very tired, increased risk of getting an infection, bleeding and bruising easily, diarrhoea or constipation, hair loss. […] Chemotherapy for CML can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have.

• #40 Chronic Myeloid Leukemia (CML) – Leukemia / Bone Marrow Transplant Program

  https://www.leukemiabmtprogram.org/patients-support-givers/diseases-treatments/leukemia/chronic-myelogenous-leukemia-cml/

  Since Imatinib was first marketed in 2002, several other tyrosine kinase inhibitors have been developed. They include dasatinib (Sprycel), nilotinib (Tasigna), bosutinib (bosulif) and ponatinib. In general these later drugs are more potent and are used for patients that do not have an adequate response to imatinib or have difficult to manage side effects to Imatinib. While tyrosine kinase inhibitors are often used as the initial therapy in CML patients, a stem cell transplant may be recommended for patients with high-risk CML particularly in later stages of disease (accelerated or blast phase) or for patients that have had a poor response or tolerance to tyrosine kinase inhibitor therapy. […] IFN is given by injection on a daily basis and helps to control blood counts in some but not all patients with CML. This therapy results in a longer survival (6-7 years on average) than patients treated with hydrea; however, IFN does have many potential side effects. These include, fever, sweats, weight loss, fatigue, bone and muscle pain which may interfere with quality of life. Currently interferon is not used frequently because of better treatment options available.

• #41 Management of Chronic Myelogenous Leukemia

  https://www.uspharmacist.com/article/management-of-chronic-myelogenous-leukemia

  Treatment for CML has changed in recent years due to advances in the understanding of the molecular basis of the disease and technology, facilitating the discovery of therapy aimed at inhibiting factors related to pathogenesis and disease progression. […] The goal of treatment for CML began to shift in the 1970s with allogeneic SCT. This procedure offered a means to eradicate Ph through various myelosuppressive and immunosuppressive treatment combinations, termed conditioning regimens, of chemotherapy and radiation. Thus, a realistic chance for a cure became available. […] In the 1980s, interferon-alpha offered patients with CP-CML a possibility for hematologic and cytogenetic responses with the elimination of Ph. […] In the 1990s, based on the hypothesis that selective inhibition of BCR-ABL tyrosine kinase activity might be effective in the treatment of Ph+ leukemias, along with a better appreciation of the interactions of the ATP-binding site of BCR-ABL, several small molecules with therapeutic potential were developed. One of these compounds (originally named CGP-57148 and then STI-571) was found to inhibit the BCR-ABL kinase containing clones in vitro and led to their destruction via apoptosis. This compound represented the first targeted therapy created specifically to inhibit the molecular abnormality believed responsible for pathogenesis.

• #42 Chronic Myeloid Leukemia (CML): Staging and Treatment | OncoLink

  https://www.oncolink.org/cancers/blood-cancers/chronic-myelogenous-leukemia-cml/chronic-myeloid-leukemia-cml-staging-and-treatment

  Bone marrow transplants are not a first-line therapy for CML patients but may be used in patients who are no longer responding to TKI therapy. […] Other types of treatments may be used in cases where TKIs are no longer working to manage the disease. These include: […] Omacetaxine mepesuccinate (Synribo) is a manmade form of homoharringtonine, a compound purified from a Chinese evergreen tree. It can be used in patients who have not responded to 2 or more TKI medications. […] Interferon alfa may be used in pregnant women and for others who cannot have a transplant. […] Chemotherapy: May be used in combination with TKI in preparation for transplant. […] Radiation: May be used to palliate (relieve) symptoms related to bone pain or an enlarged spleen. […] Surgery: In some people with CML, the spleen can become enlarged and press against other organs. A splenectomy (removal of the spleen) may be needed.

• #43 Chronic Myeloid Leukemia (CML): Radiation Therapy | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/chronic-myeloid-leukemia-cml-radiation-therapy

  Chemotherapy is the most common treatment for CML, but in rare case, radiation therapy is also used. It might be used if: […] You have bone pain. If chemo isn’t working, radiation can help stop the growth of leukemia cells. This can help ease pain caused by the overgrowth of leukemia cells in your bone marrow. […] Youre getting ready for a stem cell transplant. This is rarely done for CML, but radiation therapy to the whole body kills not only leukemia cells, but also your bone marrow cells. This can help keep you from rejecting the transplanted stem cells. It’s called total body irradiation. Equal doses of radiation are sent to all parts of your body.

• #44 Chronic myeloid leukemia | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/chronic-myeloid-leukemia

  Chemotherapy used to be a common treatment for CML. However, TKIs are now known to be more effective, so chemotherapy will be used only if TKIs aren’t working or as part of a stem cell transplant. […] Radiation is used only under certain circumstances. For example, it may be used to shrink an enlarged spleen that’s causing symptoms, such as loss of appetite. Radiation may also be administered as part of a stem cell transplant or to treat bone pain caused by leukemia cell growth in the bone marrow. […] UCSF is dedicated to improving outcomes for patients with CML. Interested patients may have opportunities to participate in clinical trials investigating promising treatments for chronic myeloid leukemia.

• #45 How We Treat Chronic Myelogenous Leukemia | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/chronic-myelogenous-leukemia/treatment

  In some cases, CML may become resistant to treatment. Fortunately, there are options available. You will have more testing, and we will discuss your treatment options. These may include targeted therapy used in a different combination or given at a different dose, or a stem cell transplant. […] The Adult Leukemia Program operates a large and growing research program. We typically have clinical trials actively enrolling patients for the treatment of CML, including trials of newer agents for patients who have developed resistance.

• #46 Chronic Myeloid Leukemia (CML): Treatment Choices

  https://healthlibrary.brighamandwomens.org/Conditions/Cancer/Specific/LeukemiaCML/34,BCMLT2

  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. Still, 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 healthcare provider to find out if there are any clinical trials you should think about. […] At first, thinking about treatment choices may seem overwhelming. Talk with your healthcare 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 healthcare providers before making a decision.

• #47 CML Clinical Trials and Latest Treatment Options

  https://www.healthline.com/health/chronic-myeloid-leukemia/cml-clinical-trials

  Researchers are exploring new treatment options for chronic myeloid leukemia (CML). Many treatments that have recently been studied or are currently under investigation are targeted therapy drugs. […] Targeted therapy drugs called tyrosine kinase inhibitors (TKIs) that target the BCR-ABL protein seem to work very well for many people, and several of these drugs have recently been approved by the Food and Drug Administration (FDA). […] The Food and Drug Administration (FDA) granted accelerated approval to asciminib for newly diagnosed Philadelphia chromosome-positive CML in October 2024. Asciminib is a tyrosine kinase inhibitor (TKI) targeted therapy drug sold under the brand name Scemblix. […] In September 2023, the FDA granted approval to bosutinib for use in children ages 1 year and older with chronic phase Philadelphia chromosome-positive CML. Bosutinib is another TKI targeted therapy drug.

• #48 4 Innovative Chronic Myeloid Leukemia Treatment Options | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/chronic-myeloid-leukemia/chronic-myeloid-leukemia-treatment-.html

  A stem cell transplant may be needed for patients whose leukemia has returned or has not responded to standard treatments. It may also be recommended if the patient has a high-risk form of leukemia that would make a cure with standard treatments unlikely. […] MD Anderson offers multiple clinical trials for CML. Many of these cannot be found anywhere else. Trials explore new drug combinations and new drugs, including targeted therapies and immunotherapies.

• #49 Chronic Myeloid Leukemia (CML): Symptoms, Treatment & Prognosis

  https://my.clevelandclinic.org/health/diseases/21845-chronic-myelogenous-leukemia-cml

  TKIs have made a huge difference for people with chronic myeloid leukemia. Before TKIs, only about 20% of people with the condition were alive five years after diagnosis. TKIs changed that outcome for people with early (chronic) CML. […] Most people take TKIs for the rest of their lives. However, recent studies show CML remains in remission even after people stop taking TKIs. This is treatment-free remission. […] If TKIs aren’t effective, providers may use chemotherapy along with or instead of a TKI. […] Right now, allogeneic stem cell transplantation is the only way to cure chronic myeloid leukemia. Allogeneic stem cell transplantation uses donated stem cells. Its a complicated medical treatment. Its side effects are more serious than targeted therapy side effects. For that reason, providers typically only use stem cell transplantation to treat resistant CML.

• #50 Chronic myelogenous leukemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-myelogenous-leukemia/diagnosis-treatment/drc-20352422

  The goal of chronic myelogenous leukemia treatment is to eliminate the blood cells that contain the BCR-ABL gene. For most people, treatment begins with targeted therapy that may help achieve a long-term remission of the disease. […] Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted therapy can cause cancer cells to die. In chronic myelogenous leukemia, the target of these medicines is the tyrosine kinase protein produced by the BCR-ABL gene. The medicines are called tyrosine kinase inhibitors, also known as TKIs. […] TKIs are the initial treatment for people diagnosed with chronic myelogenous leukemia. Side effects of these targeted medicines include swelling or puffiness of the skin, nausea, muscle cramps, fatigue, diarrhea, and skin rashes.

• #51 CML treatment and side effects | Blood Cancer UK

  https://bloodcancer.org.uk/understanding-blood-cancer/leukaemia/chronic-myeloid-leukaemia-cml/cml-treatment-side-effects/

  The aim of treatment is to keep the CML under control and manage any symptoms you have. Most people will be able to have their treatment at home and live a normal life, but some may experience a few side effects. Discover what treatment for CML looks like and what to expect. […] Most people with CML are treated with tyrosine kinase inhibitors (TKIs). These are drugs that come in tablet form, which you take daily. […] Some people might need to explore different treatment, for example if they can’t tolerate TKIs or become pregnant. […] Not everyone will experience side effects from their treatment, but it is possible that you might get some. Most side effects are mild, and can be treated. […] Having CML shouldn’t affect your ability to have a family, but there are a few things it’s good to be aware of if you want to have children.

• #52 Chronic myelogenous leukemia | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/chronic-myelogenous-leukemia?content_id=CON-20167627

  TKIs are the initial treatment for people diagnosed with chronic myelogenous leukemia. Side effects of these targeted medicines include swelling or puffiness of the skin, nausea, muscle cramps, fatigue, diarrhea, and skin rashes. […] A bone marrow transplant, also called a stem cell transplant, is the only treatment that can cure chronic myelogenous leukemia. However, it’s usually reserved for people who haven’t been helped by other treatments. […] Chemotherapy uses strong medicines to kill cancer cells. Chemotherapy medicines are sometimes combined with targeted therapy to treat aggressive chronic myelogenous leukemia. […] Clinical trials are studies of new treatments. These studies provide a chance to try the latest treatments. The risk of side effects might not be known. Ask your health care provider if you might be able to be in a clinical trial.

• #53 Treatment for Chronic Myeloid Leukemia (CML) | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/leukemias/treatment/chronic-myeloid-leukemia

  Although imatinib is effective at controlling CML in most patients, a very small number experience adverse side effects. In addition, over time, some patients become resistant to imatinib when the BCR/ABL protein mutates and imatinib can no longer interact with it. If imatinib is not effective, your doctors may recommend one of two newer drugs called dasatinib or nilotinib. In some cases, your doctor may recommend one of these medications as upfront treatment. There is somewhat less experience with these drugs as compared with imatinib, although two recent studies suggest that compared to imatinib, dasatinib and nilotinib may be more efficient in clearing the bone marrow of leukemia cells, and may work faster. In some instances, your doctor may recommend one drug over the other if you have problems with your lungs or heart. During treatment with any of these three medications, patients are monitored frequently to assess their response and to check for side effects.

• #54 Treating Chronic Myeloid Leukemia | American Cancer Society

  https://www.cancer.org/cancer/types/chronic-myeloid-leukemia/treating.html

  You may hear about alternative or complementary methods to relieve symptoms or treat your cancer that your doctors havent mentioned. […] Be sure to talk to your cancer care team about any method you are thinking about using. […] Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. […] For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. […] Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms.

• #55 Chronic Myelogenous Leukemia Treatment (PDQ®): Treatment – Patient Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.chronic-myelogenous-leukemia-treatment-pdq%C2%AE-treatment-patient-information-nci.ncicdr0000258006

  Chronic myelogenous leukemia can relapse (return) after it has been treated. […] There are different types of treatment for patients with chronic myelogenous leukemia. […] Six types of standard treatment are used: […] Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. […] Tyrosine kinase inhibitor therapy: This treatment blocks the enzyme, tyrosine kinase, that causes stem cells to develop into more white blood cells (blasts) than the body needs. […] Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. […] Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. […] High doses of chemotherapy are given to kill cancer cells.

• #56 Chronic Myeloid Leukemia (CML) in Children and Teens – Together by St. Jude™

  https://together.stjude.org/en-us/conditions/cancers/chronic-myeloid-leukemia-cml.html

  Drugs called tyrosine kinase inhibitors (TKIs) are the first line of treatment. They target tyrosine kinase enzymes, which cause leukemia cells to grow and divide quickly. […] First-line treatment for CML is usually the drug imatinib (Gleevec). This drug is a type of targeted therapy known as tyrosine kinase inhibitor (TKI). Tyrosine kinase is a property of certain enzymes made by the body. The tyrosine kinase activity can become too high in cancer, causing cancer cells to grow. Imatinib blocks the tyrosine kinase activity and helps stop the growth of cancer cells. […] Other TKI drugs called dasatinib, nilotinib, and ponatinib are sometimes used if patients cannot tolerate imatinib. These drugs are sometimes called 2nd generation TKIs. […] During treatment, doctors closely watch how patients respond to therapy. This is called monitoring. Monitoring may include a health history, physical exam, complete blood count, and molecular testing.

• #57 Chronic Myeloid Leukemia | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/c/chronic-myeloid-leukemia

  Watching how your child responds to medicines is a key part of CML treatment. Doctors will test your child’s blood and/or bone marrow at certain times to track response to therapy and to help guide long-term management. When disease is no longer detected, your child is considered in remission. Many patients remain in remission on TKI therapy for many years. […] If a child’s CML returns after a period of remission, switching to a different TKI medication can often put the CML back into remission. […] Treatment with stem cell transplant (also called a bone marrow transplant) involves taking healthy stem cells from a donor and transplanting them into your child’s bloodstream. The healthy stem cells make their way to the child’s bone marrow and start producing normal white blood cells, red blood cells and platelets. […] Stem cell transplants are challenging procedures for patients but can provide long-term cure. […] A child may receive TKI therapy after stem cell transplant to lower the risk of future relapse.

• #58 Treatment for CML | Fred Hutchinson Cancer Center

  https://www.fredhutch.org/en/diseases/chronic-myeloid-leukemia/treatment.html

  If TKIs are not controlling the CML well enough or if they cause side effects that bother you too much, your Fred Hutch physician has more options, such as newer therapies (including therapies you can get through clinical trials). Blood or bone marrow transplants are used if CML enters the accelerated or blast phase. […] At Fred Hutch, our standard always involves caring for you as a whole person. We help you get relief from side effects and provide many other forms of support, like integrative medicine, nutrition counseling and physical therapy. […] Your doctor may recommend a transplant if your CML is in blast phase at diagnosis, if it progresses to accelerated or blast phase or if is not responding well to targeted therapies. […] For CML, physicians do a transplant using stem cells from a donor. This is called an allogeneic transplant.

• #59 Chronic myelogenous leukemia | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/chronic-myelogenous-leukemia?content_id=CON-20167627

  No alternative medicines have been found to treat chronic myelogenous leukemia. But alternative medicine may help you cope with fatigue, which is common in people with chronic myelogenous leukemia. […] For many people, chronic myelogenous leukemia is a disease they will live with for years. Many will continue treatment with targeted therapy indefinitely.

• #60 Treatment for CML | Fred Hutchinson Cancer Center

  https://www.fredhutch.org/en/diseases/chronic-myeloid-leukemia/treatment.html

  A team of Fred Hutch transplant experts will care for you. […] Your care team will check your blood regularly. If your disease is not responding as expected, you might need a bone marrow test, too. […] Our CML experts work closely with patients to consider all the options and carefully decide if it’s safe to try a period of treatment-free remission. […] You might be wondering about possible side effects from treatment. If you are, it can be helpful to know that many of todays treatments are more targeted to cancer cells, so they dont cause the same side effects as standard chemotherapy. […] CML physicians, nurses and advanced practice providers are here to help prevent or relieve the side effects of treatment. […] We have many tools to help you feel better, such as antibiotics, vaccines and antiviral drugs to prevent or treat infections.

• #61 Chronic Myeloid Leukemia (CML) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/chronic-myeloid-leukemia-cml

  Chemotherapy, which helps to kill cancer cells (although it also affects healthy cells). […] Stem cell transplant, which is only offered as treatment in certain circumstances, may cure chronic myeloid leukemia. […] About 70% of people with chronic myeloid leukemia survive 5 years or longer. Advances in treatment therapies, particularly tyrosine kinase inhibitors, have greatly improved survivorship among people with chronic myeloid leukemia.

• #62 Treatments for chronic myeloid leukemia | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/chronic-myeloid-leukemia-cml/treatment

  Your healthcare team will create a treatment plan just for you. The plan is based on your health and specific information about the cancer. What you want is also important when planning treatment. When deciding which treatments to offer for chronic myeloid leukemia (CML), your healthcare team will consider: […] Targeted therapy with tyrosine kinase inhibitors( TKIs) is the main treatment for CML. […] Chronic myeloid leukemia (CML) in the chronic phase is treated with targeted therapy. In rare cases, a stem cell transplant may be offered. […] Chronic myeloid leukemia (CML) in the accelerated phase is treated with targeted therapy and a stem cell transplant. […] Targeted therapy is the main treatment for chronic myeloid leukemia (CML) in the blast phase. Chemotherapy or a stem cell transplant may also be used.

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