Treatment for chronic myeloid leukaemia (CML)

Most people with CML are treated with targeted therapies called tyrosine kinase inhibitors (TKIs). These block the action of the tyrosine kinase made by the leukaemia cells. You take them as tablets or capsules every day. There are several TKIs for CML.

• Imatinib - this is the most commonly used TKI.
• Nilotinib can be used in the chronic or accelerated phase if you cannot have imatinib.
• Dasatinib can be used as a first treatment in the chronic phase, or if Imatinib is causing severe side effects or is not working.

If you have a very high level of white blood cells in your blood when you are first diagnosed, you may be given chemotherapy tablets for a few days before starting TKI treatment. This is usually only until the doctors check that a TKI will work for you.

Occasionally chemotherapy is used if CML is in the blast phase. A combination of 3 or 4 drugs are given into a vein (intravenously)

Sometimes, your doctors may suggest chemotherapy followed by a stem cell transplant (sometimes called a bone marrow transplant). This might be if TKI treatment does not work, or if you are diagnosed in the blast phase. A stem cell transplant is an intensive treatment and it is not suitable for everyone.

If other treatments have not worked, some people may be given interferon alpha in the chronic phase of CML. Interferon alpha is a protein that the body normally makes during viral infections, such as flu. Scientists can make this protein in the laboratory, so it can be used as a treatment.

Doctors may also use it for women who need treatment and are pregnant or want to become pregnant.

You have interferon alpha as an injection under the skin using a very fine needle. You or a family member or friend can be taught how to give these injections, so you can have them at home.

Interferon alpha can cause different side effects. Some are like the symptoms of flu. Some of the side effects can be reduced by taking a mild painkiller, such as paracetamol, before the injection. Your doctor can give you more advice.

Some cancer treatments can affect fertility (your ability to become pregnant or make someone pregnant) or harm a developing baby. Because of this you may be advised to use contraception to prevent a pregnancy. If you want to have children or think you may in the future, talk to your doctor about this as soon as possible. They can talk to you about the possible options for planning your treatment.