Chronic Myelogenous Leukemia : Treatment Options

by National Cancer Institute

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There are different types of treatment for patients with chronic myelogenous leukemia.

Different types of treatment are available for patients with chronic myelogenous leukemia (CML). Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Six types of standard treatment are used:

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Other drug therapy

Imatinib (Gleevec) is a new type of cancer drug, called a tyrosine kinase inhibitor. It blocks the enzyme, tyrosine kinase, that causes stem cells to develop into more white blood cells (granulocytes or blasts) than the body needs.

Biologic therapy

Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

High-dose chemotherapy with stem cell transplant

High-dose chemotherapy with stem cell transplant is a method of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.

Donor lymphocyte infusion (DLI)

Donor lymphocyte infusion (DLI) is a cancer treatment that may be used after stem cell transplant. Lymphocytes (a type of white blood cell) from the stem cell transplant donor are removed from the donor's blood and may be frozen for storage. The donor's lymphocytes are thawed if they were frozen and then given to the patient through one or more infusions. The lymphocytes see the patient's cancer cells as not belonging to the body and attack them.

Surgery

Splenectomy is surgery to remove the spleen.

New types of treatment are being tested in clinical trials.

Treatment Options for Chronic Myelogenous Leukemia

Chronic Phase Chronic Myelogenous Leukemia

Treatment of chronic phase chronic myelogenous leukemia may include the following:

• High-dose chemotherapy with donor stem cell transplant.
• Biologic therapy (interferon) with or without chemotherapy.
• Other drug therapy (Gleevec).
• Chemotherapy.
• Splenectomy.
• A clinical trial of lower-dose chemotherapy with donor stem cell transplant.
• A clinical trial of a new treatment.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Accelerated Phase Chronic Myelogenous Leukemia

Treatment of accelerated phase chronic myelogenous leukemia may include the following:

• Stem cell transplant.
• Other drug therapy (Gleevec).
• Biologic therapy (interferon) with or without chemotherapy.
• High-dose chemotherapy.
• Chemotherapy.
• Transfusion therapy to replace red blood cells, platelets, and sometimes white blood cells, to relieve symptoms and improve quality of life.
• A clinical trial of a new treatment.

Blastic Phase Chronic Myelogenous Leukemia

Treatment of blastic phase chronic myelogenous leukemia may include the following:

• Other drug therapy (Gleevec).
• Chemotherapy using one or more drugs.
• High-dose chemotherapy.
• Donor stem cell transplant.
• Chemotherapy as palliative therapy to relieve symptoms and improve quality of life.
• A clinical trial of a new treatment.

Relapsed Chronic Myelogenous Leukemia

Treatment of relapsed chronic myelogenous leukemia may include the following:

• Donor stem cell transplant.
• Donor lymphocyte infusion.
• Biologic therapy (interferon).
• A clinical trial of biologic therapy, combination chemotherapy, or other drug therapy (Gleevec).

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