Treatment
Treatment for CML depends on the phase, subtype, lab test results, and other prognostic factors. You may receive any of the following standard treatments:
Click Image to Enlarge.
Chemotherapy
Chemotherapy is the use of drugs to treat rapidly growing cancer cells in an effort to destroy them. Chemotherapy medications may be given through the vein (intravenously) or by mouth (orally). Doctors usually give a combination of different chemotherapy drugs to treat CML. Your doctor may also recommend CNS sanctuary therapy using intrathecal chemotherapy. Your doctor will inject chemotherapy drugs into the layers of tissue that surround your brain in order to prevent the cancer from spreading to your brain or spinal cord. Intrathecal chemotherapy is reserved for advanced phases of CML, essentially in patients with lymphoid blast crisis. Targeted therapy with the tyrosine kinase inhibitors such as imatinib, dasatinib, and ponatinib may b egiven in combination with chemotherapy. Allogeneic stem cell transplantation should be offered to patients who are candidates for intensive therapies.
Click Image to Enlarge.
Targeted Therapy
Targeted therapy is one of the main treatments for CML. In CML, the Philadelphia chromosome causes your bone marrow to produce too much tyrosine kinase, an enzyme that fuels cancer cell growth. Tyrosine kinase inhibitors are a form of targeted therapy that prevents this process from occurring. Targeted therapy is usually the first treatment for newly diagnosed patients with chronic phase CML.
Click Image to Enlarge.
High-dose chemotherapy & Stem-cell transplantation
This procedure allows patients to receive large doses of chemotherapy. These high doses destroy healthy cells in the blood and bone marrow, as well as cancer cells. After chemotherapy, the patient receives blood-forming stem cells that help the body form new, healthy blood cells. Patients with CML usually receive allogeneic transplants, in which the transplant comes from a matched donor. This procedure is essentially recommended for advanced phases of CML and for patients in chronic phase who failed treatment with multiple TKIs.
Donor Lymphocyte Infusion
Your doctor may recommend this procedure after a stem-cell transplant. Your doctor will infuse lymphocytes from a donor into your blood to try to stimulate the "graft-vs-cancer" effect, in which the donor's lymphocytes see your cancer as foreign and attack it. With the availability of TKIs, DLI like allogeneic stem cell transplantation are rarely performed in chronic phase disease.
Click Image to Enlarge.
Biological Therapy
Biological therapy stimulates your body's immune system to help destroy cancer cells. It stimulates the body's natural defense system. There are several immunotherapy drugs that either stimulate your entire immune system, or your immune system response to CML cells. Biological therapy for CML is still mainly investigational.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
