CML treatments

Here we answer some FAQs

How does my doctor decide the best treatment for me?1

When choosing a treatment for CML, your doctor should describe the goals of your treatment and discuss the options available with you. He or she will also consider:

  • Your age
  • Any other health conditions you have, and treatments prescribed for those conditions
  • What side effects the different CML treatments can have

What treatments are available for CML?

Hydroxyurea1
Hydroxyurea is sometimes used for people who have a lot of symptoms and urgently need treatment at diagnosis, but who don’t have confirmation that they have the Philadelphia (Ph) chromosome or the BCR-ABL1 fusion gene. As soon as this has been confirmed, treatment with tyrosine-kinase inhibitors (TKIs) should be started.

Tyrosine-kinase inhibitors1
TKIs are a class of medicines that block the BCR-ABL1 protein. This stops the growth of abnormal white blood cells. Learn how your healthcare team will monitor your treatment response in the Understanding your results article.

The TKIs available for CML are listed below. Your doctor may adapt the dose depending on how you respond. He or she may also prescribe a combination, for example a TKI together with a medicine called interferon alpha (IFNα).1

  • Imatinib (Glivec®, Novartis Europharm Ltd; Imatinib Teva®, Teva B.V.;3 Imatinib medac®, Medac,3 Imatinib Actavis®, Actavis Group PTC ehf;3 and Imatinib Accord®, Accord Healthcare Ltd)
  • Nilotinib (Tasigna®, Novartis Europharm Ltd)4 
  • Dasatinib (Sprycel®, Bristol-Myers Squibb Pharma EEIG)5
  • Bosutinib (Bosulif®, Pfizer Ltd)6 
  • Ponatinib (Iclusig®, Incyte Biosciences Distribution B.V.)7 

What side effects can I get from the TKIs?

Like all medicines, TKIs can cause side effects. The different TKIs have different side effects, which your doctor will discuss with you. You can also read about the side effects in the patient information leaflet.

If you are worried about a side effect you are experiencing, you should call your hospital or tell your doctor or nurse straight away.

How long will I need to take the TKIs for?1

If the TKI you have been prescribed is working well for you, your doctor may recommend that you to take it indefinitely. For people who have a very good response to treatment for a number of years, there may be a possibility to come off treatment. This is called treatment-free remission (TFR). Learn more about TFR below. 

How can I maximise my chances of a good response to TKIs?1

You are much more likely to have a good response to TKI treatments if you follow the treatment recommendations that you agreed with your doctor. Talk to your doctor or nurse if for any reason you find it difficult to take your TKI as prescribed. They are there to help you get the best out of your TKI treatment.

Transplant1

Transplant using a donor (also called “allogenic stem cell transplantation”) is recommended for people who are in chronic phase CML where TKIs are not working, or for patients who are at high risk of progressing to accelerated and blast phases. Learn more about transplants in Stem cell transplants – the lowdown.

What is treatment free remission?1

Treatment free remission (TFR) is when someone who has a very good response can stop taking TKI treatment under close supervision of their healthcare team. Minimum requirements include:

  • Your hospital must have proper, high-quality and certified monitoring of treatment response
  • You are in chronic phase CML
  • You’ve had an optimal response to first-line treatment
  • You’ve had a deep molecular response for 2 years or more

You can talk to your healthcare team about whether TFR could be an option for you. Up to 3 out of 10 (30%) people who stop treatment will experience pain in their muscles and bones. This is called a TKI withdrawal syndrome.

It is important to not stop taking TKI treatment without first discussing this with your doctor.
  1. Hochhaus A, Saussele S, Rosti G, Mahon F-X, Janssen JJWM, Hjorth-Hansen H, et al. (2017) Chronic myeloid leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Annals of Oncology, Jul 1;28(suppl_4):iv41–51.
  2. Novartis Europharm Ltd. Glivec SmPC. Accessed May 2018.

  3. Novartis Europharm Ltd. Tasigna SmPC. Accessed May 2018.

  4. Bristol-Myers Squibb Pharma EEIG. Sprycel SmPC. Accessed May 2018.

  5. Bosulif SmPC. Pfizer Ltd. Accessed May 2018.

  6. Incyte Biosciences Distribution B.V. Iclusig SmPC. Accessed May 2018.