Chronic myeloid leukaemia - Treating chronic myeloid leukaemia

Imatinib tablets are usually given as soon as you have been diagnosed with chronic myeloid leukaemia, to slow its progression. These tablets are taken every day for life, and most patients do really well on them.

The aim of treatment is to achieve the following:

• by three months, correct the blood count
• by 12 months, clear the bone marrow of cells containing the Philadelphia chromosome (see Causes page for information on this)
• by 18 months, get to a stage where the leukaemia can only be detected by a very sensitive molecular test (molecular remission)

Chemotherapy is usually offered if the cancer reaches an advanced stage.

These treatments are explained below.

Treating early-stage chronic myeloid leukaemia

Imatinib

A medicine called imatinib is the main treatment recommended for chronic myeloid leukaemia. It is usually given as soon as a diagnosis is made because the medicine is designed to slow the progression of the cancer and to prevent the condition reaching the accelerated or advanced phase.

Imatinib is a type of tyrosine kinase inhibitor. This means it blocks a protein called tyrosine kinase (tyrosine kinase helps to stimulate the growth of cancer cells). This reduces the production of abnormal white blood cells.

Imatinib is taken as a tablet. The side effects of imatinib are usually mild and should improve with time. They include:

• nausea
• vomiting
• swelling in the face and lower legs
• muscle cramps
• rash
• diarrhoea

Nilotinib

It is estimated that 10-40% of people who take imatinib become resistant to its effects, so an alternative treatment is required.

The National Institute for Health and Care Excellence (NICE) has recommended nilotinib for the treatment of chronic myeloid leukaemia that is resistant or intolerant to imantinib. In some cases, nilotinib is recommended as the first treatment.

Nilotinib works in a similar way to imatinib in that it blocks the effects of proteins that help stimulate the growth of cancer cells.

Side effects of nilotinib can include:

• vomiting
• abdominal pain
• bone and joint pain
• dry skin
• loss of appetite
• hair loss
• insomnia
• night sweats
• dizziness
• tingling or numbness

If the side effects become particularly troublesome, temporarily stopping the treatment usually helps to bring them under control. Treatment can then be resumed, possibly using a lower dose of medication.

Read about the complications of chronic myeloid leukaemia for more information and advice about being vulnerable to infection and bleeding.

Treating advanced chronic myeloid leukaemia

Chemotherapy

Once chronic myeloid leukaemia has progressed to a more advanced stage, chemotherapy is the next treatment.

Chemotherapy tablets are usually used first because they have fewer and milder side effects than chemotherapy injections. Side effects include:

• tiredness
• skin rash
• increased vulnerability to infection

Chemotherapy can weaken your immune system, which helps protect you against infection. This is known as being immunocompromised.

See chronic leukaemia – complications for more information about this.

If your symptoms persist or get worse, chemotherapy injections (intravenous chemotherapy) will need to be used. Intravenous chemotherapy causes more side effects than chemotherapy tablets and they tend to be more severe.

Side effects include:

• nausea
• vomiting
• tiredness
• hair loss
• infertility

These side effects should resolve after your treatment has finished, although there is a risk that infertility could be permanent.

Bone marrow and stem cell transplants

A bone marrow transplant can offer a cure for chronic leukaemia, although it is only suitable and necessary for some patients.

Before transplantation can take place, the person receiving the transplant has to have aggressive, high-dose chemotherapy and radiotherapy to destroy any cancerous cells in their body.

This can put enormous strain on the body and can cause significant side effects and potential complications. Transplantations have better outcomes if the donor has the same tissue type as the person who is receiving the donation. The best candidate to provide a donation is usually a brother or sister with the same tissue type.

Due to these issues, transplantations are usually only successful when they are carried out in children and young people, or older people in good health, and there is a suitable brother or sister who can provide a donation.

In most cases of chronic leukaemia, the potential risks of transplantation far outweigh any benefit. For example, the chances of an elderly person with advanced chronic leukaemia surviving a bone marrow transplant can be as low as one in five.

However, your specific circumstances may mean that the benefits of treatment outweigh the risks.

Read more about bone marrow transplants.