With today’s medicines, most people with chronic myeloid leukemia (CML) have a normal lifespan and a good quality of life. The key is to get care from CML experts — like the physicians at Fred Hutchinson Cancer Center — who know the complex factors that go into choosing the right treatments for you at the right time.
Our CML specialists work closely with you, your family and each other to get you back to health. At Fred Hutch, we provide all standard therapies for CML and offer you access to the latest innovations through clinical trials.
Typically, the main treatment is oral targeted therapy. Targeted therapies have changed CML from a life-threatening illness to a chronic condition that we can manage. We also use chemotherapy, interferon, blood and marrow transplants and new therapies.
As you go through treatment, your needs may change. Your care team at Fred Hutch is with you each step of the way. For example, we will help you deal with any side effects you have. We may suggest adding a new therapy that was just approved. Even if you are able to stop CML treatment, as some people are, we will keep seeing you to protect your health over the long term.
CML treatment is highly customized and tailored to meet each patient’s needs.
Your Fred Hutch hematologist-oncologist works with an entire group that specializes in leukemias like CML. The team depends on the phase of CML and may include other hematologist-oncologists, medical oncologists, radiation oncologists, blood and bone marrow transplant specialists and researchers who are looking for better ways to treat this disease.
Every week, this team meets in one room. The meeting is called a tumor board. Together, dozens of team members discuss their patients’ treatment plans. This approach means you benefit from the experience of the whole group.
With support from the larger team, your physician will:
Your oncologist will walk you and your caregiver through the treatment plan that the tumor board has recommended for you. You will have a chance to share your personal preferences, and you will decide together what happens next.
The treatment plan we design for you depends on many things, including:
The first treatment most people get is a targeted therapy called a tyrosine kinase inhibitor (TKI). There are several TKIs to choose from. Some patients need to try different doses or different TKIs to find a therapy that has strong, lasting results and side effects they can manage.
If TKIs are not controlling the CML well enough or if they cause side effects that bother you too much, your Fred Hutch dphysician 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.
The goals in chronic-phase CML are to give you a normal lifespan, reduce any symptoms you have and put your disease into remission. The goal in the accelerated or blast phase is to put the disease into remission or get it back to the chronic 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.
Our patients can choose to receive promising new CML therapies that you can get only through a clinical trial. Many people come to Fred Hutch to be part of these studies. Your care team will tell you about studies that might be right for you, so you can think about joining them.
Compared with standard chemotherapy, which affects all fast-growing cells throughout the body, targeted therapies are more exact. They work in one of three ways:
TKIs block an enzyme that allows white blood cells to grow out of control. Without the enzyme, CML cells die quickly.
We have many TKIs to treat CML, including imatinib, dasatinib, nilotinib, bosutinib, ponatinib and asciminib. These medicines tend to work best for people with chronic-phase disease, but they may also help in the accelerated or blast phase. Several are used as first-line treatments. Some are used only if needed after trying other treatments.
Your oncologist will prescribe your targeted therapy. For CML, all targeted therapies are pills that you take at home (rather than infusions given in the clinic, like most standard chemotherapy).
Most people with CML stay on TKIs for the rest of their life. Some people with a very good, long-lasting response may be able to change to a lower dose or stop taking TKIs altogether. It’s important to work with a CML specialist to weigh the benefits and risks before deciding to change or stop treatment.
Chemotherapy uses medicines to kill fast-growing cells (like cancer cells) or to keep them from dividing, which is how cancers grow. If your disease is in the blast phase, your hematologist-oncologist may recommend chemotherapy along with targeted therapy.
Your hematologist-oncologist prescribes your chemotherapy and sets your treatment schedule. Chemotherapy may be given by injection or infusion. For an infusion, liquid medicine is put into a vein through an intravenous (IV) line. This can be a line in your arm (peripheral venous catheter) or a port in your chest (central venous catheter). Treatment happens in repeating cycles.
You will get infusions in a dedicated area of the clinic. Cancer nurses who are experts in infusions will give you these treatments. They will watch over you during treatment, deal with any medical issues that come up and help keep you comfortable.
Interferon-alpha (IFN-α) is an older CML therapy that keeps the cancer cells from dividing and prompts the immune system to fight the disease. Today, it is rarely used because targeted therapies tend to work better with fewer side effects.
Omacetaxine is a medicine that blocks production of certain proteins important to CML. It is approved for use in later lines of therapy for people with chronic and accelerated-phase CML.
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. (For other diseases, they may use stem cells from the patient’s own body.) First, you receive strong chemotherapy to get rid of your CML. Then the donor’s healthy stem cells restart your body’s ability to make blood cells. Also, white blood cells from the donor may see any remaining CML cells as foreign and attack them.
A team of Fred Hutch transplant experts will care for you. Your team will include a transplant oncologist, transplant nurse, physician assistant or advanced registered nurse practitioner, pharmacist, registered dietitian, team coordinator and social worker.
Physicians and researchers at Fred Hutch pioneered blood and marrow transplants decades ago. Today, we continue to refine transplant techniques and to develop new options.
While you are in active treatment, your CML care team will see you regularly for exams and tests to check:
It is important to check how well your treatment is working, especially early on. If your disease is not responding well, if it gets worse or if the side effects are too intense, you may need to switch medicines or try a different type of treatment. Follow-up visits are very important, even if you feel well and have no signs of disease.
Just like we personalize your treatment plan for you, we personalize your follow-up schedule, too. We update your treatment plan over time based on the best scientific evidence as well as how your disease behaves and what you prefer.
Along with treating your CML, Fred Hutch provides a range of services to support you and your caregiver before, during and after treatment. This is part of how we take care of you — not just your disease.
From registered dietitians to chaplains, we have experts who specialize in caring for people with cancer. We understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need.
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