With modern treatments, it's often possible to control chronic myeloid leukaemia (CML) for many years. In a small number of cases, it may be possible to cure it completely.
The main treatments are described below.
A medicine called imatinib is now the main treatment for CML. It's usually given soon after a diagnosis is made to slow the progression of the cancer and stop it reaching an advanced phase.
Imatinib works by reducing the production of abnormal white blood cells. It's taken as a tablet once a day.
The side effects of imatinib are usually mild and should improve with time.
They can include:
Regular blood tests and occasional tests of your bone marrow will be carried out to check whether the treatment is working. If it does work, it will usually be taken for life.
If you can't take imatinib or it doesn't work for you, a medicine called nilotinib may be recommended instead. It's also sometimes used as the first treatment for CML.
Nilotinib works in a similar way to imatinib and is taken as a capsule twice a day. If blood and bone marrow tests show the treatment is working, it's also usually taken for life.
Common side effects of nilotinib include:
If the side effects become particularly troublesome, temporarily stopping treatment usually helps to bring them under control. Treatment can then be resumed, possibly at a lower dose.
If you can't take imatinib or nilotinib, or they don't work for you, a similar medicine called dasatinib may be recommended.
This is taken as a tablet once a day and is taken for life if blood and bone marrow tests show it's working.
Side effects of dasatinib can include:
Bosutinib is a similar medication to imatinib, nilotinib and dasatinib. It may be recommended if you can't take these medications, or you've tried them and they haven't helped.
Bosutinib is taken as a tablet once a day and is taken for life if blood and bone marrow tests show it is working.
Common side effects of bosutinib include:
For more information, see the National Institute for Health and Care Excellence (NICE) guidelines on bosutinib for previously treated chronic myeloid leukaemia.
Ponatinib is a similar medication to those mentioned above, but it's only recommended for people with a specific genetic change (mutation) called the T315I mutation.
It's taken as a tablet once a day and is taken for life if blood and bone marrow tests show it's working.
Side effects of ponatinib can include:
Chemotherapy may be recommended if you can't take the medications above, or if CML has progressed to a more advanced stage. It may also be used while you're awaiting tests results to confirm you have CML.
Chemotherapy involves taking medication to kill the cancerous cells. Tablets are usually used first because they have fewer and milder side effects than chemotherapy injections.
Side effects can include:
If your symptoms persist or get worse, chemotherapy injections may be used. These have more side effects than tablets and they tend to be more severe.
In addition to the side effects mentioned above, side effects of chemotherapy injections can include:
The side effects should pass after your treatment has finished, although there's a risk that infertility could be permanent.
A stem cell or bone marrow transplant is the only potential cure for CML, but it's a very intensive treatment and isn't suitable for many people with the condition.
This is where donated cells called stem cells (which produce white blood cells) are transplanted into your body so you start to produce healthy white blood cells.
A stem cell transplant involves:
The high doses of chemotherapy and radiotherapy can put an enormous strain on the body and can cause significant side effects and life-threatening complications.
Transplants are generally only considered in younger people with CML, people in good general health and ideally those with a sibling who can provide a donation, as it's more likely to be successful in these cases.
But in many cases of CML, the potential risks of transplantation far outweigh the potential benefits, particularly now that treatment with imatinib can often keep the condition under control for many years.