Leukemia - Chronic Myeloid - CMLLast Updated: July 09, 2009 This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/09 Overview
Leukemia is a cancer of the blood. Leukemia begins when normal blood cells change and grow uncontrollably. Chronic myeloid leukemia (CML) is a cancer of the blood-producing cells of the bone marrow (the spongy, red tissue in the inner part of the large bones) that primarily results in an increase in the number of white blood cells (cells that normally fight infection). CML is also sometimes called chronic granulocytic, chronic myelocytic, or chronic myelogenous leukemia. CML makes up about 9% of all new cases of leukemia. People with CML have an acquired genetic abnormality or mutation in their bone marrow cells, in which part of one chromosome (a long strand of genes) breaks off and reattaches to another chromosome. This type of genetic exchange is called a translocation. In CML, part of chromosome 9 breaks off and fuses to a section of chromosome 22, resulting in what is called the Philadelphia chromosome or Ph chromosome. The translocation causes two genes called BCR and ABL to fuse into one gene called BCR-ABL. This mutation is found only in the blood-forming cells, not in other organs of the body, and is not inherited. Therefore, there is no concern about an increased risk to other family members. The BCR-ABL gene causes myeloid cells to produce an abnormal enzyme that allows white blood cells to grow out of control. Ordinarily, the number of white blood cells is tightly controlled by the body—more white blood cells are produced during infections or times of stress, but then return to normal when the infection is cured. In CML, the abnormal BCR-ABL enzyme is like a switch that is stuck in the “on” position—it keeps stimulating the white blood cells to grow. In addition to the elevated white blood cell count, the number of blood platelets (cells that help the blood to clot) often increase, and the number of red blood cells, which carry oxygen, may decrease. Statistics In 2009, an estimated 5,050 people of all ages (2,930 males and 2,120 females) in the United States will be diagnosed with CML. Most of these will be adults; CML is rare in children. It is estimated that 470 deaths (220 males and 250 females) will occur. The five-year relative survival rate (the percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases) for people with CML depends on the phase of the disease, other biologic characteristics of the CML, and the response of the disease to treatment. Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with CML. Because survival statistics are measured in five-year intervals, they may not represent recent advances made in the treatment or diagnosis of this cancer. This statement is particularly true of CML, because major improvements in treatment have occurred during the past decade. Statistics adapted from the American Cancer Society's publication, Cancer Facts and Figures 2009. Find out more about basic cancer terms used in this section. Medical Illustrations
Risk Factors
A risk factor is anything that increases a person’s chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health care choices. The cause of CML is not known, though researchers now understand how the disease develops from genetic changes in myeloid cells. Environmental factors account for only a small number of CML cases, and family history does not appear to play a role in the development of CML. The following factors may raise a person’s risk of developing CML: Age. The average age of a person with CML is 67. CML is uncommon in children and adolescents. Radiation exposure. There was an increase in the rate of CML seen in Japan in long-term survivors of the atomic bombings. However, there is no proven link in the occurrence of CML following radiation therapy or chemotherapy given for other types of cancer or other diseases. Gender. Men have a slightly higher risk of CML than women. Symptoms
People with CML may experience the following symptoms. Sometimes, people with CML do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor.
CML progresses slowly, and symptoms may not appear for a long time. The symptoms are usually mild at first and get worse slowly. Many people do not have any symptoms when they are diagnosed with CML. Diagnosis
Doctors use many tests to diagnose cancer and determine more about the disease. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may also be used. Your doctor may consider these factors when choosing a diagnostic test:
The following tests may be used to diagnose or monitor CML: Blood tests. Many people are diagnosed with CML before they have any symptoms through a blood test, called a complete blood count (CBC), which counts the number of different kinds of cells in the blood. A CBC is often done as part of a regular physical examination. People with CML have high levels of white blood cells. In advanced stages of CML, there may be low levels of red blood cells (anemia) or either elevated or decreased numbers of platelets. Bone marrow biopsy. In a bone marrow biopsy, a doctor takes a sample of marrow, usually from the back of the hipbone, with a needle. The patient is given medication to numb the area beforehand. The cells from the marrow, along with the cells from the blood, are analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). Marrow samples may also undergo cytogenetic analysis (see next). Cytogenetics. Cytogenetics is the analysis of a cell’s chromosomes, including the number, size, shape, and arrangement of the chromosomes. This test can often be done on the peripheral (circulating) blood at the time of diagnosis. After treatment, though, cytogenetics is performed on the bone marrow sample. All people with CML have the Philadelphia chromosome or the BCR-ABL fusion gene (described in the Overview), so the presence of either is used to confirm the diagnosis. In a small percentage of patients, there are clinical findings that first suggest CML, but the patients do not have the Philadelphia chromosome or the BCR-ABL fusion gene; therefore, they have a different type of chronic myeloproliferative disease (a disease in which there is too many red blood cells, white blood cells, or platelets). Treatment of this disease is different from that of CML. Cytogenetic testing is also used to monitor how well treatment is working and if it is reducing the number of cells with the Philadelphia chromosome. The following tests are sometimes used in conjunction with cytogenetic testing:
Imaging tests. Doctors may use imaging tests to determine if the cancer is affecting other parts of the body. For example, a computed tomography (CT or CAT) scan or ultrasound examination is sometimes used to assess the size of the spleen in patients with CML. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail. An ultrasound uses high-frequency sound waves to produce images of the inside of the body. Learn more about what to expect when having common tests, procedures, and scans. Find out more about common terms used during a diagnosis of cancer. Phases The clinical course of CML is divided into three different phases: chronic, accelerated, or blastic. This classification helps doctors plan treatment and predict prognosis (chance of recovery). Chronic phase. The blood and bone marrow contain less than 5% blasts (immature leukemia cells) in samples of blood and bone marrow. This phase often lasts for several years. About 90% of people are in chronic phase at the time of diagnosis. Accelerated phase. In the accelerated phase, there are more than 5%, but less than 30%, blasts in both the peripheral blood and bone marrow. These cells often have new cytogenetic changes, which develop as the CML cells gain more mutations (DNA damage) and grow faster. Blastic phase (blast crisis). In the blastic phase, there are more than 30% blasts in the peripheral blood or bone marrow. It develops when the CML cells begin behaving like acute leukemia. Patients in blast crisis often have fever, malaise (feeling unwell), an enlarged spleen, weight loss, and other symptoms. Without effective treatment, CML in all patients in chronic phase will move into blast crisis approximately five years after diagnosis. The time for the disease to move to blast crisis is generally shorter for patients who have certain specific findings at the time of diagnosis, including higher numbers of blasts or cells called basophils (a special type of white blood cell), chromosome changes in addition to the Philadelphia chromosome, significant elevations of the white blood cell count, or greater enlargement of the spleen. Phases
The clinical course of CML is divided into three different phases: chronic, accelerated, or blastic. This classification helps doctors plan treatment and predict prognosis (chance of recovery). Chronic phase. The blood and bone marrow contain less than 5% blasts (immature leukemia cells) in samples of blood and bone marrow. This phase often lasts for several years. About 90% of people are in chronic phase at the time of diagnosis. Without effective treatment, CML in all patients in chronic phase will move into blast crisis in an average of approximately five years after diagnosis. The time for the disease to move to blast crisis is generally shorter in patients who have certain specific findings at the time of diagnosis, including higher numbers of blasts or cells called basophils (a special type of white blood cell), chromosome changes in addition to the Philadelphia chromosome, significant elevations of the white blood cell count, or greater enlargement of the spleen. Treatment
The treatment of CML depends on the phase of the disease and the patient’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan. This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials as a treatment option when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section. Descriptions of the most common treatment options for CML are listed below, along with information on measuring treatment effectiveness and common treatment recommendations outlined by the disease phase. Targeted treatments: tyrosine kinase inhibitors These drugs are a type of targeted therapy, which is treatment that targets faulty genes or proteins that contribute to cancer growth and development. In this case, the target is a specialized protein called the BCR-ABL tyrosine kinase enzyme that is involved in CML. Imatinib Imatinib (Gleevec) was approved by the U.S. Food and Drug Administration (FDA) in 2001 for the treatment of all phases of CML. This drug has the unique ability to specifically inhibit the action of the BCR-ABL enzyme, which in turn results in the rapid death of the CML cells. Imatinib may also be used to treat adult acute lymphocytic leukemia (ALL). This drug has changed standard treatment for CML. It is given in pill form once or twice a day and causes fewer side effects than previous treatments. Nearly all patients in the chronic stage given the drug experience a complete normalization of blood counts and shrinkage of the spleen. Most importantly, the cells with the Philadelphia chromosome are eliminated, as evaluated by cytogenetic studies, in 80% to 90% of newly diagnosed patients in the chronic phase. This is called a complete cytogenetic remission (CCyR). The recurrence rate in patients whose cancer completely responds to imatinib has been very low, and it is now clear that patients with a significant reduction in the Philadelphia chromosome will remain in chronic phase longer with imatinib, compared with previous therapies. Although it is too soon to know how long these responses will last or if patients will be cured with this medication alone, there are large numbers of patients who were treated with imatinib in the initial clinical trials in 1999 who remain in complete cytogenetic remission. Imatinib is now considered the treatment of choice for chronic phase CML, although bone marrow transplantation may also be a primary treatment option for younger patients (see below). Side effects of imatinib are mild but can include slight nausea, changes in blood counts, fluid retention, swelling around the eyes, and muscle cramps. If a patient’s CML responds well to imatinib (there is no evidence of the Philadelphia chromosome and the patient has a normal level of blood cell counts), the patient should stay on this medication indefinitely. Dasatinib The FDA approved dasatinib (Sprycel) for the treatment of adults with CML and Philadelphia-positive ALL when previous treatment, including imatinib, did not work, stopped working, or could not be given. Dasatinib is a pill that may be taken once or twice a day, depending on the dose. The side effects of dasatinib include anemia, neutropenia (low levels of white blood cells), thrombocytopenia (low platelet counts), and fluid around the lungs. Health care providers will monitor the patient’s blood counts frequently after starting dasatinib and may adjust dosing or stop giving the drug temporarily if the patient’s blood counts drop too low. Dasatinib may also cause bleeding, fluid retention, diarrhea, rash, headache, fatigue, and nausea. Nilotinib In 2007, the FDA approved nilotinib (Tasigna) for patients with Philadelphia chromosome-positive chronic phase or accelerated phase CML, when previous treatment, including imatinib, did not work, stopped working, or could not be given. Nilotinib is in the form of a capsule that patients take by mouth. The most serious side effect of nilotinib includes possible life-threatening heart problems that can lead to an irregular heartbeat and possible sudden death. However, this side effect is rare. Common side effects include low blood counts, rash, headache, nausea, and itching. Other possible but uncommon serious side effects include liver damage, fluid accumulation, and inflammation of the pancreas. It is important for people taking imatinib, dasatinib, or nilotinib to take the medication on a regular basis to delay the development of disease resistance to these drugs. Talk with your doctor for more information. Measuring treatment effectiveness Patients receiving treatment with any of these drugs should be regularly monitored to see how well the treatment is working. The response of CML includes: • A complete hematologic response: the white blood cell and platelet counts have returned to normal, the spleen is of normal size and cannot be felt on physical examination, and the patient has no symptoms of CML • A partial response: the blood counts are still abnormal, there may still be some immature blasts present in the blood, and the spleen may still be enlarged, but the symptoms and blood tests are improved compared with those before treatment Other specific tests are used to detect the number of cells that have the Philadelphia chromosome or contain the BCR-ABL fusion gene. At diagnosis, the Philadelphia chromosome is present in almost all of the marrow cells. Once a person’s cancer shows a complete hematologic response, the doctor then measures the cancer’s cytogenetic response. • A complete cytogenetic response means there are no cells with the Philadelphia chromosome detected by cytogenetic analysis.
The goal of treatment is to achieve a complete cytogenetic response evaluated by performing a bone marrow biopsy, when other tests such as FISH done on a sample of the patient’s blood, suggest that the Philadelphia chromosome has been noticeably reduced. Other more sensitive tests include FISH and PCR (see Diagnosis section), which can be done on a blood sample and are typically performed several times a year. Patients who have no cells with the Philadelphia chromosome by regular cytogenetic analysis are often monitored by the PCR test with the goal of a molecular response, which means that there has been at least a thousand fold reduction in the amount of BCR-ABL. Sometimes, a tyrosine kinase drug stops working and the CML develops resistance to it. Apparent resistance can occur if patients do not take their medication regularly, as prescribed. Even in patients who do take the medication appropriately, the CML may become resistant to imatinib, which is why it is important to monitor the cancer with cytogenetics, FISH, or PCR to evaluate how well the drug is working. Chemotherapy Chemotherapy is the use of drugs to kill cancer cells. In systemic chemotherapy, the drugs travel through the bloodstream to cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication, or a hematologist, a doctor who specializes in treating blood diseases. Some people may receive chemotherapy in their doctor's office; others may go to the hospital. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific time. Because chemotherapy affects normal cells as well as cancer cells, many people experience side effects from treatment. Side effects depend on the specific drug and the dosage. Common side effects include nausea and vomiting, loss of appetite, diarrhea, fatigue, low blood count, bleeding or bruising after minor cuts or injuries, numbness and tingling in the hands or feet, headaches, hair loss, and darkening of the skin and fingernails. Side effects usually go away when treatment is complete. A drug called hydroxyurea (Hydrea, Droxia) is often given initially to reduce the white blood cell count until the definite diagnosis of CML is made with the tests described above. Given orally (in pill form), the drug is effective at normalizing the blood counts and reducing the size of the spleen, but it does not eliminate the cells with the Philadelphia chromosome and does not prevent the onset of blast crisis. Although hydroxyurea has few side effects and is well tolerated, most newly diagnosed patients in chronic phase are treated with imatinib as soon as possible. Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases. Stem cell transplantation/bone marrow transplantation A stem cell transplant is a medical procedure in which diseased bone marrow is replaced by highly specialized cells, called hematopoietic stem cells. Hematopoietic stem cells are found both in the bloodstream and in the bone marrow. Today, this procedure is more commonly called a stem cell transplant, rather than bone marrow transplant, because blood stem cells are typically what is being transplanted, not the actual bone marrow tissue. There are two types of stem cell transplantation depending on the source of the replacement blood stem cells: allogeneic (ALLO) and autologous (AUTO). Only ALLO transplants are used in the treatment of CML. In an ALLO transplant, stem cells are obtained from a donor whose tissue matches the patient’s on a genetic level; this testing is called HLA-typing. Most often, a patient’s brother or sister serves as the donor, although unrelated donors can serve as the donor too. Millions of people worldwide have volunteered to donate stem cells for patients who do not have matched family members; your health care team will search a computer registry to look for a match. In addition, stem cells derived from umbilical cord blood are sometimes considered if family donors are not available. In an AUTO transplant, the patient’s own stem cells are used. The stem cells are obtained from the patient when he or she is in remission from previous treatment. The stem cells are then frozen until they are needed, usually after the high-dose treatment (explained below) is completed. However, AUTO transplants are not used for patients with CML. In both types, the goal of transplantation is to destroy cancer cells in the marrow, blood, and other parts of the body and have replacement blood stem cells create healthy bone marrow. In most stem cell transplants, the patient is treated with high doses of chemotherapy and/or radiation therapy to destroy as many cancer cells as possible. This also destroys the patient’s bone marrow tissue and suppresses the patient’s immune system so that, in an ALLO transplant, the donor cells are not rejected by the body. After the high-dose treatment is given, blood stem cells are infused into the patient’s vein to replace the bone marrow and restore normal blood counts from donor cells. Sometimes, ALLO transplants can also be performed after giving lower doses of chemotherapy and/or radiation therapy that are still sufficient to suppress the immune system and allow growth of the donor cells. (These transplants, sometimes termed “mini-transplants” or “reduced intensity transplants” have less immediate side effects, allowing the procedure to be used for older patients.) For both ALLO and AUTO transplant types, the replacement cells engraft (begin to make new blood cells) and turn into healthy, blood-producing tissue in 10 days to three weeks. Destroying the patient’s own marrow reduces the body’s natural defenses, temporarily leaving the patient at an increased risk of infection. Until the patient’s immune system is back to normal, patients may need antibiotics and blood transfusions. In an ALLO transplant, another major risk is that the donor’s cells will recognize the patient’s body as foreign, causing graft-versus-host disease (GVHD). GVHD may be a serious complication of allogeneic transplants and can be fatal. Other side effects may include liver problems, diarrhea, infections, and rashes. However, GVHD can also be a benefit, in that the donor cells can recognize the cancer cells as foreign and destroy these cells, a mechanism that is one of the major reasons why ALLO transplantation generally works so well over the long term. The risk of GVHD can be reduced with exact HLA-type matching and the use of preventive drugs. Although transplantation can successfully cure CML, unsuccessful ALLO transplantations can actually shorten a patient’s life compared with less intensive treatments. Before recommending transplantation, doctors will talk with the patient about the risks of this treatment and consider several other factors, such as the type of cancer, results of any previous treatment, and patient’s age and general health. Imatinib has been so effective in suppressing CML cells that transplantation is now generally recommended only for patients whose cancer does not respond to imatinib, recurs (comes back after treatment), or worsens while being treated with imatinib. If imatinib treatment doesn’t work, the decision to undergo transplantation versus treatment with nilotinib or dasatinib can be complex and difficult, and patients are strongly encouraged to seek the advice of doctors experienced in the treatment of CML. Learn more about bone marrow and stem cell transplantation. Immunotherapy Immunotherapy (also called biologic therapy) is designed to boost the body's natural defenses to fight the cancer. It uses materials either made by the body or in a laboratory to bolster, target, or restore immune system function. Interferon is a type of immunotherapy. It can reduce the white blood cell count and sometimes decrease the number of cells that have the Philadelphia chromosome. It is given by daily injections under the skin and causes flu-like side effects, such as fever, chills, and loss of appetite. When given on an ongoing basis, it can cause fatigue, loss of energy, and memory changes. Interferon therapy was the primary treatment for chronic phase CML before imatinib became available. A clinical trial showed that imatinib was more effective than interferon, producing much higher success rates with fewer side effects. Therefore, interferon is no longer recommended as initial treatment for CML. Learn more about immunotherapy. Treatment by phase Chronic phase The immediate goals of treatment are to alleviate any symptoms the patient may be experiencing with the longer-term goal of decreasing or eliminating the cells with the Philadelphia chromosome to delay or prevent the progression of the disease to blast crisis. Treatment may include one or more of the drugs mentioned above or ALLO transplantation. Accelerated phase The same drugs used in chronic phase CML may also be used in the accelerated phase. Although treatment with imatinib can be successful during this stage, the response rate is much lower than in chronic phase, and most patients have a recurrence within about two years. Therefore, an ALLO transplant should be considered when possible. If an ALLO transplant is not recommended or if a matched donor cannot be identified, the treatment plan may include dasatinib, nilotinib, or investigational treatments being tested in clinical trials. Blastic phase Treatment with imatinib produces only short periods of response that last a few months in a small number of patients in blast crisis, but it can help to control the CML while transplantation is being arranged. Transplantation is less successful than in chronic phase, but some patients have been successfully treated with this approach. Many people with CML in blastic phase are treated with chemotherapy usually used for patients with acute myeloid leukemia (AML). The chance of remission from this approach is about 20%; most patients’ leukemia recurs within weeks to a few months. Hydroxyurea is frequently given to patients because it can help control blood counts. If transplantation is not an option, the doctor may recommend experimental treatments being tested in clinical trials. Find out more about common terms used during cancer treatment. Clinical Trials Resources
Doctors and scientists are always looking for better ways to treat patients with CML. A clinical trial is a way to test a new treatment to prove that it is safe, effective, and possibly better than a standard treatment. The clinical trial may be evaluating a new drug, a new combination of existing treatments, a new approach to radiation therapy or surgery, or a new method of treatment or prevention. Patients who participate in clinical trials are among the first to receive new treatments, such as new chemotherapy before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment. Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that finding new drugs and other therapies is the only way to make progress in treating CML. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with CML. Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill”. The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials. To join a clinical trial, patients participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials , including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials. For specific topics being studied for CML, learn more in the Current Research section. Side Effects
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects do occur. Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and the person’s overall health. Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health care team if they do happen. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Learn more about the importance of addressing such needs, including concerns about managing the cost of your cancer care. Learn more about late effects or long-term side effects by reading the After Treatment section or talking with your doctor. After Treatment
As treatment for CML ends (such as after a transplant) or continues long-term (such as treatment with imatinib), talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. People treated for CML and in remission should receive lifelong follow-up examinations on a regular basis to watch for signs or symptoms of recurrence or late effects (side effects that occur years after treatment). People treated for CML are encouraged to follow established recommendations for good health, such as not smoking, eating a balanced diet, maintaining a healthy weight, and receiving appropriate screening for other types of cancer. Learn more about healthy living after cancer For many patients, imatinib is an ongoing cancer therapy. Any decision to discontinue this treatment should be decided by a patient and doctor together, based these how well imatinib continues to work and the extent of the side effects. Find out more about common terms used after cancer treatment is complete. Current Research
Research for CML is ongoing. The following advances may still be under investigation in clinical trials and may not be approved or available at this current time. Always discuss all diagnostic and treatment options with your doctor. Sometimes, CML becomes resistant to imatinib when there is the development of new mutations in the BCR-ABL fusion gene, which prevents the binding of imatinib to the enzyme. Some experimental approaches to increase the effectiveness of this treatment are listed below:
Most cancer centers are actively involved in clinical trials aimed at increasing the rate of cure from CML. The National Cancer Institute’s Clinical Trials Cooperative Group Program sponsors many of these studies. Please talk with your doctor about these ongoing clinical trials. Questions to Ask the Doctor
Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor:
Patient Information Resources
In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains a list of national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease. View organizations that offer information on this specific type of cancer. |
