Chronic Myelogenous Leukemia

Treatment

The goal of chronic myelogenous leukemia (CML) treatment is to eliminate the blood and bone marrow cells with the abnormal gene that cause the overproduction of diseased blood cells and damage your bone marrow. CML treatment options include targeted drugs, bone marrow transplantation, chemotherapy and experimental therapies. Your Mayo Clinic team partners with you and your family to create a treatment plan appropriate for your needs.

Targeted drug therapy

Targeted therapy involves using a class of drugs called tyrosine kinase inhibitors (TKIs) to attack cancer cells and interfere with their growth. The abnormal gene, BCR-ABL, found in many people with CML, produces a tyrosine kinase, an abnormal protein that creates excess diseased blood cells that damage your bone marrow.

• Imatinib (Gleevec). Imatinib has typically been the first-choice drug for people who are newly diagnosed but now nilotinib (below) is an effective option.
• Dasatinib (Sprycel). This TKI drug is used to treat cases of CML that are resistant to imatinib.
• Nilotinib (Tasigna). Nilotinib is a TKI that can be effective for people who don't respond to treatment with imatinib or can't tolerate the medication. The Food and Drug Administration also approved nilotinib for use in individuals with newly diagnosed cases of CML, and it appears to be more effective than imatinib.

Bone marrow transplantation

If drug treatment is not successful, you may be a candidate for a bone marrow transplant. Your doctor may recommend one of these transplant types:

• Allogeneic transplant (full-intensity myeloablative). An allogeneic transplant involves infusing healthy stem cells from a relative or other donor into your body. Before the transplantation, you are treated with high doses of chemotherapy and sometimes radiation therapy to kill leukemia cells.
• Reduced-intensity transplant (nonmyeloablative). This type of allogeneic transplant uses a less intense conditioning regimen before your stem cell transplant to prepare your body for the procedure. This procedure is usually considered for older individuals or those with significant health issues.

Chemotherapy

A number of chemotherapy drugs, administered through a vein (intravenously) or by mouth, treat CML by killing cancer cells.

Experimental treatments

In addition to standard treatment, some Mayo Clinic patients may choose to receive experimental therapies. Your treatment team can help determine if you qualify as a clinical trial participant.