Your treatment for chronic myeloid leukemia (CML) will be determined by your physician based on:

• Your age, overall health, and medical history
• The extent of the disease
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference
  

Gleevec^® (imatinib) - In 1999 imatinib mesylate was introduced as a treatment for CML. It is considered a breakthrough because it is now shown to be the best and safest treatment for CML. Imatinib is taken orally every day at a dose of 400 milligrams. With this dosage, 90 percent of patients followed for 5 years are alive, with most doing well. Side effects are minimal and include nausea, vomiting, diarrhea, skin rashes, muscle cramps, bone aches, and others. Most patients (90 percent or more) lead a normal life on treatment. Imatinib is now considered front-line therapy for CML by most experts regardless of your age or availability of donors for transplant.

Allogeneic stem cell transplant - It cures 40 percent to 80 percent of patients. However, it can cause mortality (5 percent to 30 percent) and long-term chronic morbidities (GVHD, cataracts, hip necrosis, infertility, other cancers, and reduced quality of life). Most experts now feel that allogeneic transplant should be considered only in patients who do not respond to imatinib.

Others - A new drug—called Sprycel^TM (dasatinib)—that is more potent than imatinib was approved by the FDA in 2006 for the treatment of patients who progress on imatinib or cannot tolerate it. Tasigna^TM (nilotinib) has also been recently approved as another option for these such patients.  

Other agents include investigational drugs, such as SKI606, INN0406, homoharringtonine, decitabine, and vaccines. Established drugs also include hydroxyurea, interferon alpha, anagrelide, and other chemotherapy drugs.

General Guidelines for Treatment of CML

Imatinib - now recommended as frontline therapy for all patients regardless of age or donor availability.

Allogeneic SCT - is recommended only in patients who progress on imatinib.

New tyrosine kinase inhibitors (dasatinib, nilotinib) - also recommended in patients who progress/are intolerant to imatinib.

Other agents - interferon-a, hydroxyurea, busulfan, and anagrelide. Recommended as interim treatment or in combinations, rarely alone.