Treatment for CML

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.

Treatment Plan

CML treatment is highly customized and tailored to meet each patient’s needs.

How Do We Create Your Treatment Plan?

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:

  • Talk about all possible treatments for your situation
  • Decide which therapies will be most promising for you
  • Check if any clinical trials match your needs, so you can consider joining them

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.

Why Do Treatment Plans Differ?

The treatment plan we design for you depends on many things, including:

  • The phase of your CML (chronic, accelerated or blast — based mainly on the number of immature white blood cells in your blood and bone marrow and other chromosome changes)
  • Your age, overall health and other medical conditions
  • Your needs and preferences, like if you want to have children in the future (because some therapies may affect fertility) and if you want to join a clinical trial

What Is The Standard Therapy For CML?

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.

Treatment Process

We choose, combine and schedule your therapies based on what works for CML like yours. Your care team will make sure you understand each type of treatment and all of your choices.

Targeted Therapy

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:

  • They target a gene or protein that causes cancer growth.
  • They damage cancer cells directly.
  • They tell your immune system to attack certain cells. This is also called immunotherapy.

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.

Learn More About Targeted Therapy


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.

Learn More About Chemotherapy

Other Medicines

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.  

Learn More About Other Medicines

Blood and Marrow Transplant

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.

Learn More About Blood and Marrow Transplants

Monitoring Your Health

While you are in active treatment, your CML care team will see you regularly for exams and tests to check:

  • How well your treatment is working
  • If there is any reason to change your treatment
  • If you need help with side effects or supportive care services, like nutrition care or mental health counseling

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.

Possible Results of Treatment

Your care team will check your blood regularly. If your disease is not responding as expected, you might need a bone marrow test, too. Your doctor will be looking for these responses: 

  • Hematologic response: Your blood cell counts and spleen size are normal. Most people with CML have this response within three months of starting therapy.
  • Molecular response: This is based on the amount of BCR-ABL (the abnormal gene in CML) in your blood. In your first year of treatment, your physician will look for specific molecular responses that are linked with having a normal lifespan. Most people with CML stay on targeted therapies for the rest of their lives in order to maintain a good molecular response. A small group of patients who have a deeper molecular response that lasts several years may be able to successfully stop TKI therapy. 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.”  

Managing Side Effects

You might be wondering about possible side effects from treatment. If you are, it can be helpful to know that many of today’s treatments are more targeted to cancer cells, so they don’t cause the same side effects as standard chemotherapy. 

You are always at the center of everything we do. CML physicians, nurses and advanced practice providers are here to help prevent or relieve the side effects of treatment.

Get Help with Side Effects

Before you begin treatment, we talk with you about what to expect, based on your treatment plan, and what can help if you do have side effects. We will work closely with you to make sure that side effects are managed.

At your appointments, we want you to tell us about any side effects you are having. If you have questions or concerns between appointments, you can call or email us. We will make sure you know how to reach care providers at Fred Hutch after hours, if that is when you need us.

We have many tools to help you feel better, such as:

  • Antibiotics, vaccines and antiviral drugs to prevent or treat infections
  • Databases to help avoid drug interactions
  • Nutrition care and medicines to help with digestive problems
  • Conventional and integrative therapies for pain and other side effects

Coping with Side Effects

Common Side Effects

Side effects are different depending on which treatment you get. They also depend on other things, like how strong your immune system is. These are some of the common side effects of CML treatment: 

  • Unusual tiredness (fatigue)
  • Rashes or dry skin
  • Muscle, joint or bone pain
  • Problems in your digestive tract, like stomach pain, nausea, vomiting, diarrhea or constipation
  • Headache
  • Fever or night sweats
  • Mild decreases in white blood cell, red blood cell and platelet levels  

Supportive Care Services

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. 

Learn more about Supportive Care

Caregiving During Treatment

If your loved one is getting therapy, there are many ways you can help. Caregiving during active treatment for CML often means doing tasks like these:

  • Keeping track of their appointments and driving them to and from treatment
  • Watching for changes in their condition and telling their care team about any symptoms 
  • Providing physical care, like helping them take medicines
  • Spending time with them and encouraging them
  • Taking care of things at home that they may not be able to do, like grocery shopping and cleaning

Caregiving for Transplant Patients

Caregivers have a special role in blood and marrow transplants. This intense treatment involves strong chemotherapy (and sometimes radiation) with serious side effects. During the initial recovery period, which often takes at least a month, your loved one will need daily help. We have classes to help transplant caregivers get ready. During recovery, a transplant registered nurse is available by phone 24 hours a day, 7 days a week, to help you.

Meet the Chronic Myeloid Leukemia Care Team