Treatment for chronic myeloid leukaemia (CML)

Most people with CML are treated with targeted therapies called tyrosine kinase inhibitors (TKIs). 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.

Your doctors can usually change the TKI you have if the first one:

• does not work
• causes side effects that are difficult to manage
• stops working.

When you are first diagnosed, you may have a very high level of white blood cells in your blood. If this happens, you may be given chemotherapy tablets for a few days or weeks before starting TKI treatment. Sometimes chemotherapy is given into a vein (intravenously) along with a TKI.

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

You may be offered a stem cell transplant if:

• the CML is in the blast phase
• treatment with TKIs is not controlling the CML.

If your doctor thinks a stem cell transplant may be appropriate for you, they will discuss it with you in more detail. Stem cell transplants are only done in specialist cancer treatment centres. A stem cell transplant may cure some people with CML or put the CML into remission.

A stem cell transplant allows you to have much higher doses of chemotherapy.

If you have a stem cell transplant for CML, you will usually have stem cells from someone else who is a match for you (a donor). This is called a donor stem cell transplant or an allogeneic stem cell transplant.

A donor stem cell transplant aims to replace bone marrow that is no longer working properly with healthy stem cells from another person.

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 immune system normally makes to help fight infection. Scientists can make this protein in the laboratory and use it as a treatment. In people with CML, it may help stop the bone marrow from producing too many white blood cells.

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 these side effects can be reduced by taking a mild painkiller, such as paracetamol, before the injection. Your doctor can give you more advice.

The side effects are most noticeable with the first and second injections. They usually improve after that, but the tiredness may continue.

Interferon alpha and pregnancy

Doctors may also use interferon alpha for people who need CML treatment and are planning to get pregnant, or are already pregnant. Your doctor will talk to you about the possible benefits of this treatment and any possible risks to the developing baby.

Some doctors may recommend switching from interferon alpha to a TKI in the last 3 months of pregnancy. But this will depend on your situation. Your doctor will talk to you about what treatment may be right for you.

If you are planning to become pregnant, you should discuss this with your doctor. If you are pregnant, you should tell your doctor straight away.

Some people have a very high number of white blood cells in their blood when they are diagnosed with chronic myeloid leukaemia (CML). Doctors can remove some white blood cells from the blood using a process called leukapheresis.

If you are pregnant and have a high number of white cells in your blood, your haematologist might talk to you about having leukapheresis. This can be done to improve your symptoms and is safe to use during pregnancy.