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The treatment of CML depends on the phase| of the illness. Your doctor will discuss the possible treatment options with you and the benefits and disadvantages of each.
In the chronic phase, the aim of treatment is to control symptoms and keep you feeling well for many years, possibly for a normal lifespan.
People are usually treated with a tablet called imatinib (Glivec®)|. Most people manage well on this treatment and only have mild side effects.
Imatinib is one of a group of newer ‘targeted’ drugs called tyrosine kinase inhibitors|, which have greatly improved the outlook for people with CML over the last decade. Many people have been taking imatinib for 10 years or more without any problems from their leukaemia.
Other tyrosine kinase inhibitors, such as dasatinib (Sprycel®)| and nilotinib (Tasigna®), can be used if imatinib doesn’t work or for people who can’t take it due to problems with side effects.
Stem cell transplants| (sometimes called bone marrow transplants) may be used for people who have CML that hasn’t responded to tyrosine kinase inhibitor treatment.
Imatinib can be used in the accelerated phase, but only if it hasn’t been used in the chronic phase. If imatinib isn’t used, treatment is usually a combination of chemotherapy drugs, given by injection into a vein (intravenously). High-dose treatment with a stem cell transplant may also be used for some people.
In the blast phase the aim of treatment is to reduce symptoms and try to put the leukaemia back into a second chronic phase. Imatinib may be used, as long as it hasn’t been given before. Blast phase CML is like an acute leukaemia, so combinations of chemotherapy drugs used to treat acute leukaemia are often given. If the leukaemia responds well to chemotherapy, the doctors may recommend high-dose chemotherapy treatment with a stem cell transplant.
Sometimes people have a very high number of white cells in their blood when they are diagnosed with CML. The cells can clog-up blood vessels and cause physical problems. Doctors may treat this by removing the excess cells from the blood using a machine called a cell separator. This process is called leukapheresis.
Haematologists follow national guidelines for treating CML. Your treatment will be based on these guidelines but tailored to your particular situation.
In most hospitals a team of specialists will decide on the treatment that’s best for you. This multidisciplinary team (MDT) may include:
Other staff will be available to help you if necessary, such as:
The MDT will plan your treatment by considering a number of factors, including the stage of the leukaemia and your general health.
You may be invited to take part in a clinical trial| of a new treatment for CML.
If you have any questions about your treatment, don’t be afraid to ask your doctor or nurse. It often helps to make a list of questions and to take a close friend or relative with you. They can remind you of questions you want to ask, and afterwards help you remember what the doctor said.
Before you have any treatment, your doctor will explain its aims to you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about:
If you don’t understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it’s not unusual for people to need repeated explanations.
You can always ask for more time to decide about the treatment if you feel that you can’t make a decision when it is first explained to you.
You’re also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge if you choose not to have treatment, so that they can record your decision in your medical notes. You don’t have to give a reason, but it can be helpful to let the staff know your concerns so that they can give you the best advice.
Sometimes people are frightened at the idea of having treatment for leukaemia because of the possible side effects. Although some of the treatments can cause side effects, these can usually be controlled or reduced with medicines.
If you’ve been offered treatment in the chronic phase, which aims to control the leukaemia for a long time and has few side effects, deciding whether to accept the treatment may not be difficult. However, if you are in the blast phase, and have been offered more intensive treatment, which may cause more side effects and has a lower chance of controlling the leukaemia, it may be more difficult to decide whether to go ahead.
Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to have treatment, you can still be given supportive (palliative) care to help relieve any symptoms.
Your MDT will use national treatment guidelines to decide on the most suitable treatment for you. Even so, you may want to have another medical opinion. If you feel it will be helpful, your specialist or GP will be willing to refer you to another specialist for a second opinion. If you decide to go for a second opinion it may be a good idea to take a friend or relative with you and have a list of questions prepared, so that you can make sure your concerns are covered during the discussion.
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.